感染性胰腺坏死病人多重耐药菌感染危险因素分析

Risk factors of multiple drug-resistant bacteria infection in patients with infectious pancreatic necrosis

目的探讨影响感染性胰腺坏死(IPN)病人发生多重耐药菌(MDRB)感染的相关危险因素。方法回顾性分析2014-01-01至2020-12-31首都医科大学宣武医院普通外科收治的215例IPN病人的临床资料。根据病人有无MDRB感染,分为MDRB感染组(107例)和非MDRB感染组(108例),比较两组病人的临床转归。结果MDRB感染组病人入院时CT严重指数(CTSI)评分[8(6~10)vs.6(4~8),P=0.001]和降钙素原(PCT)水平[(1.7±1.4)μg/L vs.(0.8±0.7)μg/L,P=0.001]高于非MDRB感染组病人。在临床治疗过程中,MDRB感染组病人更需要营养支持(80.4%vs.50.9%,P=0.001)、微创手术干预(88.8%vs.64.8%,P=0.001)等治疗措施。在临床转归方面,MDRB感染组病人更易发生术后并发症(23.4%vs.12.1%,P=0.029)和新发器官衰竭(11.2%vs.0.9%,P=0.002),导致重症监护室(ICU)住院时间[(30.1±28.7)d vs.(17.9±13.7)d,P=0.001]和总住院时间[(50.0±31.1)d vs.(29.0±21.5)d,P=0.001]延长。经多因素分析发现,合并胰腺外感染(OR=4.116,95%CI 1.381-12.271,P=0.011)、入院时PCT水平(OR=2.728,95%CI 1.502-4.954,P=0.001)、胰腺坏死程度(OR=2.728,95%CI 1.502-4.954,P=0.001)是影响IPN病人出现MDRB感染的独立危险因素。结论根据IPN病人是否出现胰腺外感染、胰腺坏死严重程度、入院时PCT水平可评估其发生MDRB感染的风险。

Objective To explore the related risk factors of multidrug-resistant bacteria(MDRB)infection in infected pancreatic necrosis(IPN)patients.Methods Clinical data of IPN patients admitted to the general surgery department of Xuanwu Hospital of Capital Medical University from January 1,2014 to December 31,2020 were retrospectively analyzed.A total of 215 IPN patients were enrolled in this study.According to whether the patients had MDRB infection or not,they were divided into MDRB group(107 cases)and non-MDRB group(108 cases).The baseline data,infection types,surgical procedures,perioperative and postoperative complications were recorded and compared.Results Multivariate logistic regression analysis showed that the complications of extra-pancreatic infection(OR=4.116,95%CI 1.381-12.271,P=0.011),procalcitonin(PCT)level at admission(OR=2.728,95%CI 1.502-4.954,P=0.001),and degree of pancreatic necrosis(OR=2.728,95%CI 1.502-4.954,P=0.001)were independent risk factors for MDRB infection.Conclusion Clinicians can assess the risk of MDRB infection in patients based on whether IPN patients have extrapancreatic infection,the degree of pancreatic necrosis,and the PCT level on admission.