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

Abstract

Introduction Carbapenem-resistant organisms (CRO) have emerged as a major global public health threat, but their role in critical acute pancreatitis (CAP) is still not defined. Our study aims to investigate risk factors associated with mortality and drug resistance among CAP patients with CRO infection. Methods The clinical characteristics of CAP patients with CRO infection and drug resistance of causative pathogens from January 1, 2016, to October 1, 2021, were reviewed retrospectively. Independent risk factors for mortality were determined via univariate and multivariate analyses. Result Eighty-two CAP patients suffered from CRO infection, with mortality of 60.0%. The independent risk factors for mortality were procalcitonin > 5 ng/L (hazard ratio = 2.300, 95% confidence interval = 1.180–4.484, P = 0.014) and lactic acid > 2 mmol/L (hazard ratio = 2.101, 95% confidence interval = 1.151–3.836, P = 0.016). The pancreas was the main site of infection, followed by lung, bloodstream and urinary tract. Klebsiella pneumoniae and Acinetobacter baumannii were the main pathogenic bacteria of CRO strains with extensive antibiotic resistance (> 60%) to 6 of 8 common antibiotics, except sulfamethoxazole (56.3%) and tigecycline (33.2%). Conclusion CRO infection has become a serious threat for CAP patients, with high rates of mortality. Procalcitonin and lactic acid represent two independent risk factors for mortality in CAP patients with CRO infection. Klebsiella pneumoniae and Acinetobacter baumannii are the primary categories of CRO pathogens. Greater efforts are needed for early prevention and prompt treatment of CRO infections in CAP patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-022-00624-w.

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

“…However, bacteraemia, especially sepsis shock, could worsen OF and mimic SAP. In the subgroup comparison (moderately SAP vs. SAP) in the MDR-GNB bacteraemia, the mortality was significantly increased by the severity of AP, which was also accompanied by high procalcitonin in accordance with previous studies investigating markers of severe infections ( Lin et al., 2017 ; Hong et al., 2019 ; Wu et al., 2021c ; Wu et al., 2022b ). It is worth noting that MDR-GNB bacteraemia had a mortality rate of 62.5% resultant from untimely detection and inappropriate antibiotic treatment, which has also been revealed to be associated with a greater risk of hospital mortality among critically ill patients with bacteraemia ( Diekema et al., 2019 ).…”

“…The criteria of AP aetiology were as follows: 1) biliary: radiological evidence of abdominal ultrasonography with increased serum alanine aminotransferase; 2) alcoholism: regular drink over 50 g/day; 3) hypertriglyceridemia: triglycerides of more than 5.6 mmol/L without any other clear aetiology. Gram-positive bacterial or fungal infections were defined as the presence of concomitant infections ( Wu et al., 2022b ). MDR- GNB is defined as strains not sensitive to three or more categories of antibiotics ( Wu et al., 2021b ).…”

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

“…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 ).…”

“…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). The translocation of intestinal bacteria (namely, intestinal bacteria passing through the intestinal mucosal barrier, and invading the systemic circulation and extra-intestinal organs) could cause damage to extra-intestinal organs, which led to secondary multiple organ failure and eventually to sepsis (Wang et al, 2019).…”

Clinical Value of Neutrophil CD64 Index, PCT, and CRP in Acute Pancreatitis Complicated with Abdominal Infection

“…While 20% patients of AP may develop SAP, there are two peaks in the course of acute pancreatitis; first stage is systemic inflammatory response syndrome with subsequent organ failure and second is infectious complication stage with related organ failure [ 9 , 10 ]. Without intensive care, SAP may progress into critical acute pancreatitis (CAP) with mortality rate of 34% [ 11 , 12 , 13 ]. Predicting the risk of complications and carrying out comprehensive treatment in the early stage of acute pancreatitis is the core means to improve the prognosis of patients.…”