Impact of multiple drug-resistant Gram-negative bacterial bacteraemia on infected pancreatic necrosis patients

Abstract

IntroductionMultiple drug-resistant Gram-negative bacterial (MDR-GNB) bacteraemia poses a serious threat to patients in hospital. Infected pancreatic necrosis (IPN) patients are a vulnerable population to infectious complications during hospitalization. This study aims to evaluate the impact of MDR Gram-negative bacteraemia on IPN patients.MethodsA case–control study was performed with data collected from 1 January 2016 to 1 July 2022 in a Chinese tertiary teaching hospital. Clinical data of the IPN patients with MDR-GNB bacteraemia were analyzed and compared to those of a matched control group without MDR-GNB bacteraemia (case–control ratio of 1:2). Comparisons were performed between with/without MDR-GNB bacteraemia and different severities of acute pancreatitis (AP). Independent predictors of overall mortality were identified via univariate and multivariate binary logistic regression analyses.ResultsMDR-GNB bacteraemia was related to a higher mortality rate (62.5% vs. 8.3%, p < 0.001). Severe AP combined with MDR-GNB bacteraemia further increased mortality up to 81.3% (p = 0.025). MDR-GNB bacteraemia (odds ratio (OR) = 8.976, 95% confidence interval (CI) = 1.805 –44.620, p = 0.007) and severe AP (OR = 9.414, 95% CI = 1.742 –50.873, p = 0.009) were independent predictors of overall mortality. MDR- Klebsiella pneumoniae was the most common causative pathogen.ConclusionA higher mortality rate in IPN patients was related to MDR-GNB bacteraemia and further increased in severe AP patients combined with MDR-GNB bacteraemia.

The impact of multi-drug resistant Pseudomonas aeruginosa infections on acute pancreatitis patients

“…In accordance with a previous study of other MDR bacterial infections among AP patients, we showed that the pancreas and lung were the most common sites of MDR-PA infections [ 20 ]. This indicates a similar distribution of MDR-PA with other Gram-negative bacterial and enhances the importance of strengthening the management of both pancreatic and extra-pancreatic infections in the course of AP [ 7 , 24 , 38 ].…”

“…In line with a previous study, we also found that MOF and the prescription of carbapenem antibiotics were significantly related to the CRPA infections in AP patients with MDR-PA infections [ 20 ]. This should alert the clinician to focus the MOF, as a clinical marker for antibiotics’ prescription to suspected infections, and enhance the administration of carbapenem antibiotics as a prevention for the drug-resistance progression [ 22 , 31 – 33 ].…”

“…The sites of infections were determined from consideration of inflammatory clinical characteristics and positive results from specimens. The primary infection sites were defined as the main infection sites [ 20 ]. The presence of infections was diagnosed based on the inflammatory clinical manifestations and positive results of specimens according to the criteria of the US Centers for Disease Control and Prevention.…”

“…Drug resistance to either meropenem or imipenem was based on the definition of carbapenem resistance (minimum inhibitory concentration > 2 µg/ml). Infectious pancreatic necrosis was defined as the presence of gas bubbles within the (peri)pancreatic necrosis on computed tomography and a positive culture of (peri)pancreatic necrotic fluid obtained during the first intervention [ 20 ]. Isolations of MDR-PA were defined as positive specimens obtained from blood, bronchoalveolar fluid and the first drainage of the infectious pancreatic necrosis.…”