Characteristics of and risk factors for biliary pathogen infection in patients with acute pancreatitis

Abstract

Background Infection in patients with acute pancreatitis, especially severe acute pancreatitis patients, is a common and important phenomenon, and the distributions and drug resistance profiles of bacteria causing biliary infection and related risk factors are dynamic. We conducted this study to explore the characteristics of and risk factors for bacterial infection in the biliary tract to understand antimicrobial susceptibility, promote the rational use of antibiotics, control multidrug-resistant bacterial infections and provide guidance for the treatment of acute pancreatitis caused by drug-resistant bacteria. Methods The distribution of 132 strains of biliary pathogenic bacteria in patients with acute pancreatitis from January 2016 to December 2020 were analyzed. We assessed drug resistance in the dominant Gram-negative bacteria and studied the drug resistance profiles of multidrug-resistant bacteria by classifying Enterobacteriaceae and nonfermentative bacteria. We then retrospectively analyzed the clinical data and risk factors associated with 72 strains of Gram-negative bacilli, which were divided into multidrug-resistant bacteria (50 cases) and non-multidrug-resistant bacteria (22 cases). Results The main bacteria were Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli had a 66.67% detection rate. Acinetobacter baumannii had more than 50.00% drug resistance to carbapenems, ESBL-producing Klebsiella pneumoniae had 100.00% drug resistance, and Pseudomonas aeruginosa had 66.67% resistance to carbapenems. Multivariate logistic regression analysis suggested that the administration of third- or fourth-generation cephalosporins was an independent risk factor for Gram-negative multidrug-resistant biliary bacterial infection in acute pancreatitis patients. Conclusion Drug resistance among biliary pathogens in acute pancreatitis patients remains high; therefore, rational antimicrobial drug use and control measures should be carried out considering associated risk factors to improve diagnosis and treatment quality in acute pancreatitis patients.

A nomogram for predicting the risk of mortality in patients with acute pancreatitis and Gram-negative bacilli infection

“…The rate of RAP was 15.2%, which was similar to the previously reported incidence in about 17% ( Ahmed Ali et al., 2016 ). The rate of carbapenem resistance was 45.7%, slightly lower than the ratio of beyond 50% reported by other studies ( Chen et al., 2021 ). The most common site of infection was the pancreas, and the most common causal pathogen was K. pneumoniae , which was similar to the previous literature ( Wu et al., 2022 ).…”

Risk Factors for Mortality Among Critical Acute Pancreatitis Patients with Carbapenem-Resistant Organism Infections and Drug Resistance of Causative Pathogens

“…With the overuse of antibiotics in recent years, CRO have become an important pathogen of nosocomial infections. The family Enterobacteriaceae and non-fermentative bacteria constitute the vast majority of Gram-negative bacilli, which easily develop different antibiotic resistance mechanisms, and evolve into CRO by inducing position changes and enzyme production [ 24 ]. Uncontrollable infection secondary to CAP is the leading cause of mortality in the late phase of the disease [ 16 ].…”

The distribution and antibiotic-resistant characteristics and risk factors of pathogens associated with clinical biliary tract infection in humans

“…Analysis of major risk factors was performed according to the literature ( Chen S. et al, 2021 ). The risk factors for common MDRO infections are currently believed to be age, invasive operation, treatment with three or more antimicrobial agents, and previous multiple or long-term hospitalization.…”

“…Samples with no positive indication were cultured on a blood agar medium and defined as negative if no bacteria were detected and positive if there was evidence of bacterial proliferation and the instrument was able to detect a yellow color on the bottom indicator of the culture bottles at the indicated time. Positive bile samples were transferred to blood agar, Sabouraud fungal medium, McConkey agar, and chocolate agar (Tianjin Jinzhang Biotechnology Development Co., Ltd. Tianjin, China) and incubated in 371 carbon dioxide bacteria incubators at 35°C and 5% CO 2 for 18–24 h. Anaerobic culture bags (1.5 L; Qingdao Haibo Biotechnology, Shandong, China) were used for further culture and separation, as needed ( Chen S. et al, 2021 ).…”

“…Gram-negative bacilli, which are some of the most common opportunistic pathogens in hospitals, have shown increasing trends toward drug resistance in recent years. Gram-negative bacilli mainly include those in the Enterobacteriaceae family and nonfermentative bacteria, and easily evolve into multidrug-resistant ( Chen S. et al, 2021 ) organisms (MDROs) that are resistant to three or more types of clinical antibiotics used at the same time. In recent years, with the extensive use of antibiotics for the treatment of bacterial infections, MDROs have become common and important pathogens responsible for clinical infections, resulting in an intractable challenge for clinical diagnosis and treatment ( Kawanishi et al, 2017 ); therefore, it is necessary to clarify the risk factors for MDRO infection in patients.…”