156例重症急性胰腺炎患者继发感染的病原菌检出情况及感染高危因素分析

Pathogen detection and analysis of risk factors for a secondary infection in patients with severe acute pancreatitis at this Hospital from 2016 to 2019

目的探讨本院2016年-2019年收治的重症急性胰腺炎(severe acute pancreatitis,SAP)患者继发感染的病原菌检出情况及引起感染的高危因素。方法2016年1月-2019年12月本院收治的SAP患者156例,其中继发感染46例(为继发感染组),未发生感染110例(为未继发感染组)。分析继发感染患者感染标本种类与SAP病程的关系,并观察感染病原菌的分布情况。采用单因素及多因素Logistic回归法分析SAP患者继发感染的相关因素。结果46例SAP继发感染患者共检查60份标本,其中痰液标本于SAP病程中1-2周较多,占总痰液标本的72.00%;胰腺坏死组织及胰周积液标本于SAP病程中2周较多,占总胰腺坏死组织及胰周积液标本的86.96%;血液标本于SAP病程中1周内较多,占总血液标本的66.67%。感染组共检出病原菌60株,其中革兰阴性菌32株,占53.33%,以大肠埃希菌和鲍曼不动杆菌为主;革兰阳性菌19株,占31.67%;真菌9株,占15.00%。多因素Logistic回归分析显示,禁食时间>21d、肠功能障碍时间>5d、胰腺坏死、低氧血症均是SAP患者继发感染的独立危险因素(均P<0.05)。结论随着SAP病程的发展,患者继发感染主要以胰腺坏死组织及胰周积液多见,病原菌以革兰阴性菌为主。临床上需重点关注SAP患者可能存在的胰腺坏死、低氧血症等继发感染因素,采取相应措施以预防感染的发生。

Objectives To detect pathogens and analyze risk factors for a secondary infection in patients with severe acute pancreatitis(SAP)seen at this Hospital from 2016 to 2019.Methods From January 2016 to December 2019,156 patients with SAP were seen at this Hospital,including 46 patients with a secondary infection(the group with a secondary infection),and 110 patients without an infection(the group without a secondary infection).Blood,sputum,abdominal effusions,and other samples were collected,and the samples were promptly inoculated on culture medium to isolate,culture,and identify pathogens.The relationship between the types of specimens and the course of SAP was analyzed and the distribution of pathogens was examined.Factors related to development of a secondary infection in patients with SAP were analyzed using univariate and multivariate logistic regression.Results A total of 60 samples were collected from 46 patients with an infection secondary to SAP.Sputum samples were often collected 1-2 weeks into the course of SAP,accounting for 72.00%of all sputum samples.Samples of pancreatic necrosis and peripancreatic effusions were often collected 2 weeks into the course of SAP,accounting for 86.96%of all samples of pancreatic necrosis and peripancreatic effusions.Blood samples were often collected within 1 week of the course of SAP,accounting for 66.67%of all blood samples.A total of 60 strains of pathogens were detected in the group with an infection.Pathogens included 32 strains of Gram-negative bacteria(53.33%),which were mainly Escherichia coli and Acinetobacter baumannii,19 strains of Gram-positive bacteria(31.67%),and 9 strains of fungi(15.00%).Multivariate logistic regression analysis indicated that fasting for longer than21 d,intestinal dysfunction for longer than 5 d,pancreatic necrosis,and hypoxemia were independent risk factors for a secondary infection in patients with SAP(P<0.05 for all).Conclusion As the course of SAP proceeds,patients with a secondary infection mainly exhibit pancreatic necrosis and peripancreatic effusions.Those infections are mainly caused by Gram-negative bacteria.More attention should be paid to factors for a secondary infection,such as pancreatic necrosis and hypoxemia,in patients with SAP,and corresponding measures should be taken to prevent the development of an infection.