Predictors of Mortality and Drug Resistance Among Carbapenem-Resistant Enterobacteriaceae-Infected Pancreatic Necrosis Patients

Abstract

Introduction: Carbapenem-resistant Enterobacteriaceae (CRE) has emerged as a global threat to hospitalization patients. Infected pancreatic necrosis (IPN) leads to high risks of CRE infections with increasing mortality. Our study aims to determine the predictors related to 90-day overall mortality of CRE IPN. Methods: We retrospectively reviewed the drug resistance rates and clinical characteristics of CRE IPN patients from January 1, 2016, to January 1, 2021. Independent predictors of mortality were identified via univariate and multivariate analyses. Results: During the 5-year period, 75 IPN patients suffered from 135 episodes of CRE infections with mortality up to 50.7%. CRE strains were highly resistant ([ 50%) to nine of ten common antibiotics, except tigecycline (18%). The most common pathogen was carbapenem-resistant Klebsiella pneumoniae (84 of 135). Lung was the main site of extrapancreatic infections, followed by bloodstream and biliary tract. The independent predictors of mortality were Sequential Organ Failure Assessment (SOFA) score [ 2 (hazard ratio 3.746, 95% confidence interval 1.209-11.609, P = 0.022) and procalcitonin [ 6 ng/l (hazard ratio 2.428, 95% confidence interval 1.204-4.895, P = 0.013). Conclusion: CRE is widespread as a global challenge with a high mortality rate among IPN patients due to limited therapeutic options. Carbapenem-resistant K. pneumoniae is the leading category of CRE which requires more attention in clinical practice. High SOFA score and procalcitonin level represent two independent predictors of mortality in CRE IPN patients. Greater efforts are needed toward timely therapeutic intervention for CRE IPN.

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

“…For the first time, our study suggests that the timing of first intervention should focus on lactic acid during the pre-intervention phase. In line with a previous study, our findings confirmed that procalcitonin plays a key role in the evaluation of infections, which alerts us to timely clearance of the source of infection [ 5 , 27 ]. For CRO-infected CAP patients, clinicians also need to consider the efficacy of the infectious source control which, although difficult to assess, may influence the duration of antibiotic therapy [ 28 ].…”

“…Carbapenems were previously considered the last-line choice for multidrug-resistant Gram-negative bacterial infections [ 3 , 5 , 23 ]. With the overuse of antibiotics in recent years, CRO have become an important pathogen of nosocomial infections.…”

“…Pancreatic necrosis is initially aseptic but can progress to infected necrosis if infected with intestinal bacteria among AP patients; the lung was the most common site of extra-pancreatic infection in our cohort with CRAB, which constituted the primary pathogenic bacterium, thus alerting clinicians to be wary of CRAB ventilator-associated pneumonia and subsequent IPN [ 30 ]. Since conventional disinfection methods are not effective against CRAB or CRKP, immunocompromised patients, including CAP patients, may be more susceptible to infection caused by CRO attached to medical devices and clinicians’ hands in intensive care units without thorough sterilization [ 5 , 31 ].…”

Predictors of mortality in acute pancreatitis complicated with multidrug-resistant Klebsiella pneumoniae infection

“…K. pneumoniae , as the second most common nosocomial gram-negative bacterium, leads to significantly high all-cause mortality in worldwide [ 10 , 12 , 14 , 25 ]. Carbapenem, amikacin and tigecycline used to be effective and latest antibiotics for MDR- K. pneumoniae treatments, but recent researches revealed that drug-resistance rates of these three antibiotics were significantly increasing which may be associated with overuse during treatments [ 24 , 26 ]. In this era of MDR bacterial infections, clinician in all departments should pay more attentions on the preventions and treatments of MDR- K. pneumoniae infections [ 13 , 17 ].…”

Blood Urea Nitrogen as a Prognostic Marker in Severe Acute Pancreatitis

“…To further verify this conclusion, we matched the predictors in the multivariate logistic regression model except BUN, and continuous variables including ALB and procalcitonin were stratified by the median cut-off point. In addition, confounders that reportedly affect outcomes for AP or SAP, including age, APACHE II score, and mMarshall score, were matched [5][6][7][8][9][10][11] (Table 5). After PSM, BUN levels were still higher in the mortality group than in the survival group (18.415 [IQR,19.555] mmol/L vs. 10.63 [IQR, 6.03] mmol/L; P = 0:005).…”