Risk Factors of Multidrug Resistant Pathogens Induced Infection in Severe Acute Pancreatitis

Abstract

Purpose: A retrospective study was first performed to assess the multidrug resistant (MDR) pathogen in severe acute pancreatitis (SAP) patients who were treated using the step-up approach. We aim to assess the risk factors between MDR pathogen and potential covariates in SAP patients. Methods: The clinical data of 51 SAP patients who were treated from June, 2013 to December, 2016 were retrospectively collected. A total of 23 patients in the MDR group and 28 patients in the non-MDR group were reviewed. The risk factors for MDR pathogen-induced infections in SAP patients were analyzed. Results: Hyperlipidemia was the leading cause of SAP in our study. The mean duration of hospital stay was significantly longer in the patients with MDR pathogen infections (P=0.0135). The hospitalization expenses of MDR group were much higher than those in non-MDR group. The mortality of MDR group (56.5%) was higher than that in non-MDR group (28.6%) (P=0.0436). Gram-negative isolates (63.8%) were commonly detected in SAP patients. Acinetobacter baumannii was the most common MDR pathogens. Systemic disease (P = 0.0136), initial use of carbapenem (P = 0.0438), and open necrosectomy (P = 0.0002) were the potential risk factors for MDR pathogen-induced infections in SAP. Furthermore, the logistic regression analysis revealed that open necrosectomy was the independent variable for MDR infections (OR: 15.6, 95% CI: 2.951–82.469, P = 0.0012). Conclusions: MDR pathogen-induced infections were common in SAP patients and Acinetobacter baumannii was the main pathogen. Meanwhile, open necrosectomy was the independent risk factor for the infection of MDR pathogen.

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

“…As the secondary common pathogen, E. coli was less [3]. In line with Li et al, hyperlipidemia (n = 27, 36.0%) was the most common primary etiology among Chinese AP patients complicated with CRE infections in our cohort [9]. Unhealthy lifestyles, such as eating spicy foods and high-fat diets, may be a possible reason contributing to the high proportion of hyperlipidemia in China.…”

“…Over the past decade, CRE has caused life-threatening infections with high mortality and economic burden in the global healthcare systems [ 11 , 25 ]. AP patients, especially those complicated with IPN, are vulnerable to many potential risk factors associated with acquisition of MDR bacterial or CRE infections, such as overuse of prophylactic antibiotics, longer length of hospitalizations and anti-inflammatory conditions [ 3 , 9 , 14 ]. To date, this is the first cohort study focusing on the predictor of mortality and drug resistance rate among CRE IPN patients.…”

“…The crisis of MDR bacterial infection is more frequently occurring in developing countries including China where more than half of strains are MDR [4,5]. Most publications have shown that MDR bacterial infections are significantly associated with increased mortality among AP patients, and gram-negative bacteria have replaced the gram-positive isolates as the dominating bacteria in AP patients [3,[6][7][8][9]. Carbapenems are considered as last option for MDR gram-negative bacterial infections including Enterobacteriaceae.…”

Rethinking Carbapenems: A Pharmacokinetic Approach for Antimicrobial Selection in Infected Necrotizing Pancreatitis

“…21 Some studies suggest that gram-positive organisms are more commonly isolated in INP when the infection is developed postoperatively. 22 A study assessing adverse outcomes associated with INP recovered extended-spectrum β-lactamase (ESBL) organisms in 3.19% of patients. 23 Therefore, empirical coverage of ESBLs should only be considered if a patient has risk factors for resistance.…”

“…Trends toward increased duration of therapy leading to risk of MDROs in INP have been noted (24.2 ± 21.7 days vs 16.8 ± 15.4 days; P = 0.255). 22 Additionally, length of antimicrobial therapy increases the risk for development of invasive candidiasis. 65 Guidelines offer no recommendation regarding duration of therapy.…”