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Adverse clinical outcomes associated with multidrug-resistant organisms in patients with infected pancreatic necrosis
Caihong Ning1, Gengwen Huang1, Dingcheng Shen1
1Department of Biliopancreatic Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China.
Background:
Multidrug-resistant organisms (MDROs) is becoming a serious worldwide threat to public health. However, the impact of MDROs on the outcomes of the patients with infected pancreatic necrosis (IPN) remains unclear. This study aims to evaluate the roles of MDROs in IPN.
Methods:
A prospectively maintained database of 188 patients with IPN between January 2010 and May 2019 was analyzed. The microbiology profile of organisms isolated from wall-off necrosis (WON) was specifically investigated to correlate with the outcomes of the patients.
Results:
Of the 188 patients with IPN, 108 patients (57.4%) had MDROs detected in aspirates from WON. Carbapenem-resistant Klebsiella pneumoniae (CRKP) accounted for 43.5% of the MDROs isolated (60/138), followed by Carbapenem-resistant Acinetobacter baumanii (CRAB) (34.8%, 48/138) and Escherichia coli producing an extended-spectrum beta-lactamase (ESBLp) (6.5%, 9/138). MDROs infection was associated with higher mortality (35.2% vs 11.3%, P < 0.001), higher rate of hemorrhage (36.1% vs 11.3%, P < 0.001), longer intensive care unit (ICU) stay (23 vs 12 days, P < 0.001), longer hospital stay (68 vs 51 days, P = 0.001) and more hospitalization expenses (45,190 ± 31,680 vs 26,965 ± 17,167 $, P < 0.001). Multivariate analysis of predictors of mortality indicated that MDROs infection (OR = 2.6; 95% confidence interval [CI], 1.0-6.5; P = 0.042), age ≥ 50 years (OR = 2.6; 95% CI, 1.2-5.8; P = 0.016), severe category (OR = 2.9; 95% CI, 1.1-8.0; P = 0.035), bloodstream infection (OR = 3.4; 95% CI, 1.5-7.6; P = 0.049), step-down surgical approach (OR = 2.7; 95% CI, 1.1-6.2; P = 0.023) were significant factors.
Conclusions:
MDROs infection was prevalent among patients with IPN and associated with adverse clinical outcomes and increased mortality.
Insights
Multidrug-resistant organisms (MDROs) are common in infected pancreatic necrosis (IPN), significantly increasing patient mortality and complications. Early detection and management of MDROs are crucial for improving outcomes in IPN patients.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Critical Care Medicine
Background:
- Multidrug-resistant organisms (MDROs) pose a significant global health threat.
- The impact of MDROs on infected pancreatic necrosis (IPN) patient outcomes is not well understood.
Purpose of the Study:
- To investigate the prevalence of MDROs in patients with IPN.
- To evaluate the association between MDROs and clinical outcomes in IPN patients.
Main Methods:
- Analysis of a prospectively maintained database of 188 IPN patients (January 2010 - May 2019).
- Microbiology profiling of organisms isolated from wall-off necrosis (WON).
- Correlation of MDRO detection with patient outcomes, including mortality, hemorrhage, ICU stay, hospital stay, and expenses.
Main Results:
- MDROs were detected in 57.4% of IPN patients.
- Carbapenem-resistant Klebsiella pneumoniae (CRKP) and Carbapenem-resistant Acinetobacter baumanii (CRAB) were the most common MDROs.
- MDRO infection was linked to higher mortality (35.2% vs. 11.3%), increased hemorrhage, longer ICU and hospital stays, and greater hospitalization costs.
- Multivariate analysis identified MDRO infection as a significant predictor of mortality.
Conclusions:
- MDRO infection is prevalent in IPN patients.
- MDROs are associated with adverse clinical outcomes and increased mortality in IPN.
- Findings underscore the importance of addressing MDROs in IPN management.
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