ESKAPE血流感染对急性坏死型胰腺炎预后的影响

Impact of ESKAPE bloodstream infection on prognosis of acute necrotizing pancreatitis

目的:探讨ESKAPE血流感染对急性坏死性胰腺炎(ANP)患者预后及并发症的影响。方法:回顾性分析2003年1月—2014年7月收治的有血培养结果的87例ANP患者,其中血培养阴性49例,阳性38例,分析血流感染,尤其是ESKAPE血流感染对ANP患者治疗结果的影响。结果:在38例血培养阳性ANP患者的69份的病原学结果中,40.6%为ESKAPE,其中鲍曼不动杆菌占比50.0%,其余依次为屎肠球菌(14.3%)、肺炎克雷伯菌(10.7%),肠杆菌属(10.7%),金黄色葡萄球菌(7.1%)和铜绿假单胞菌(7.1%)。血流感染患者休克、呼吸衰竭、肾功能衰竭与消化道出血等并发症的发生率、病死率、住院费用及ICU住院天数均较非血流感染患者明显增高(均P<0.05);ESKAPE血流感染患者休克发生率以及住院费用均高于非ESKAPE血流感染患者(均P<0.05)。结论:血流感染明显增加ANP患者的并发症和病死率。ESKAPE是导致ANP患者血流感染的主要病原体,其与患者休克的发生密切相关。

Objective：To investigate the impact of ESKAPE bloodstream infection on the prognosis and complications in patients with acute necrotizing pancreatitis（ANP）.Methods：Eighty-seven ANP patients admitted from January 2003 to July 2014 with blood culture results were retrospectively studied.Of the patients,49 cases had negative and 38 cases had positive blood culture.The impact of bloodstream infection,especially ESKAPE bloodstream infection on therapeutic outcomes of these ANP patients was analyzed.Results：In the 69 pathogen test results from the 38 ANP patients with positive blood culture,40.6%were ESKAPE pathogens that included Acinetobacter baumanni（50.0%）,Enterococcus faecium（14.3%）,Klebsiella pneumonia（10.7%）,Enterobacter species（10.7%）,Staphylococcus aureus（7.1%） and Pseudomonas aeruginosa（7.1%）.Patients with bloodstream infection had significantly increased incidence of shock,respiratory failure,renal failure and digestive tract bleeding and mortality,as well as increased hospital expenses and prolonged length of ICU stay compared with those without bloodstream infection（all P〈0.05）.Patients with ESKAPE bloodstream infection had higher incidence of shock and hospital expenses than those with non-ESKAPE bloodstream infection（both P〈0.05）.Conclusion：Bloodstream infection can significantly increase the complications and mortality in ANP patients.ESKAPE are the major pathogens resulting in bloodstream infection in ANP patients,and are also closely associated with occurrence of shock in the patients.