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Clinical Characteristics of Acute Pancreatitis Patients with Multidrug-Resistant Bacterial Infection
Guilan Cheng1, Dingxi Wang1, Ping Zhu2
1Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, People's Republic of China.
Background:
There are few published reports describing the clinical characteristics of acute pancreatitis (AP) patients with multidrug-resistant organism (MDRO) infection.
Methods:
This was a retrospective analysis of AP patients with MDRO infection in West China Hospital between July 2015 and June 2020. Basic clinical data, disease progression states, and prognoses of the MDRO and non-MDRO infection groups were compared and analyzed. Logistic regression analysis was performed to explore the related risk factors for MDRO infection. The prognoses of different MDRO infection types were compared.
Results:
In total, 9812 AP patients were included, 2436 (24.83%) of whom had healthcare-associated infections (641 [26.31%] MDRO infections and 1795 [73.69%] non-MDRO infections). The main MDRO strain was carbapenem-resistant Acinetobacter baumannii (CRAB) (400/62.40%). The rate of discharge against doctor's advice, mortality, hospitalization expenses, and hospitalization days was higher in the MDRO infection group than in the noninfection group. By logistic regression analysis, the independent risk factors associated with MDRO infection included male sex (OR 1.36, 95% CI 1.09~1.70), severity (OR 1.40, 95% CI 1.10~1.78), ICU referral (OR 2.48, 95% CI 1.79~3.44), abdominal puncture (OR 2.78, 95% CI 1.93~4.02), fiberoptic bronchoscopy (OR 1.95, CI 1.35~2.81), and PICC/CVC placement (OR 1.48, CI 1.06~2.06). Compared with biliary and hypertriglyceridemia (HTG) (OR 0.94, 95% CI 0.73~1.23), alcohol (OR 0.30, 95% CI 0.19~0.47) and other etiologies (OR 0.58, 95% CI 0.41~0.81) conferred a lower risk of MDRO infection. The carbapenem-resistant Klebsiella pneumoniae (CRKP) infection rate was highest in the patients who died.
Conclusion:
The CRAB proportion was highest in AP patients with MDRO infection. MDRO infection is related to many factors, has a poor prognosis, and increases the patient burden. CRKP infection is directly related to poor prognosis.
Insights
Multidrug-resistant organism (MDRO) infections in acute pancreatitis (AP) patients are linked to increased mortality and hospitalization. Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection specifically correlates with a poorer prognosis.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Critical Care Medicine
Background:
- Limited data exists on the clinical characteristics of acute pancreatitis (AP) patients with multidrug-resistant organism (MDRO) infections.
- Healthcare-associated infections (HAIs) are a significant concern in hospitalized patients.
Purpose of the Study:
- To analyze the clinical characteristics and risk factors of MDRO infections in AP patients.
- To compare the prognosis of patients with MDRO infections versus non-MDRO infections.
- To identify specific MDRO strains associated with poor outcomes.
Main Methods:
- Retrospective analysis of 9812 AP patients from July 2015 to June 2020.
- Comparison of clinical data, disease progression, and prognoses between MDRO and non-MDRO infection groups.
- Logistic regression analysis to identify risk factors for MDRO infection.
Main Results:
- 24.83% of AP patients had HAIs, with 26.31% of these being MDRO infections.
- Carbapenem-resistant Acinetobacter baumannii (CRAB) was the most common MDRO strain.
- MDRO infections were associated with higher rates of discharge against medical advice, mortality, hospitalization expenses, and longer hospital stays.
- Independent risk factors for MDRO infection included male sex, disease severity, ICU referral, abdominal puncture, fiberoptic bronchoscopy, and central venous catheter placement.
- Alcohol and other etiologies conferred a lower risk of MDRO infection compared to biliary and hypertriglyceridemia-induced AP.
- Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection was most prevalent in non-survivors.
Conclusions:
- MDRO infections in AP patients are associated with increased patient burden and poor prognosis.
- CRAB is the predominant MDRO strain in this population.
- CRKP infection is a significant indicator of poor prognosis in AP patients.
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