Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5162
Peer-review started: June 26, 2019
First decision: July 20, 2019
Revised: August 7, 2019
Accepted: August 19, 2019
Article in press: August 19, 2019
Published online: September 14, 2019
Acute pancreatitis (AP) is a common acute abdominal disease worldwide, and its incidence rate has increased annually. Approximately 20% of AP patients develop into necrotizing pancreatitis (NP), and 40% to 70% of NP patients have infectious complications, which usually indicate a worse prognosis. Infection is an important sign of complications in NP patients.
To investigate the difference in infection time, infection site, and infectious strain in NP patients with infectious complications.
The clinical data of AP patients visiting the Department of General Surgery of Xuanwu Hospital of Capital Medical University from January 1, 2014 to December 31, 2018 were collected retrospectively. Enhanced computerized tomography or magnetic resonance imaging findings in patients with NP were included in the study. Statistical analysis of infectious bacteria, infection site, and infection time in NP patients with infectious complications was performed, because knowledge about pathogens and their antibiotic susceptibility patterns is essential for selecting an appropriate antibiotic. In addition, the factors that might influence the prognosis of patients were analyzed.
In this study, 539 strains of pathogenic bacteria were isolated from 162 patients with NP infection, including 212 strains from pancreatic infections and 327 strains from extrapancreatic infections. Gram-negative bacteria were the main infectious species, the most common of which were Escherichia coli and Pseudomonas aeruginosa. The extrapancreatic infection time (9.1 ± 8.8 d) was earlier than the pancreatic infection time (13.9 ± 12.3 d). Among NP patients with early extrapancreatic infection (< 14 d), bacteremia (25.12%) and respiratory tract infection (21.26%) were predominant. Among NP patients with late extrapancreatic infection (> 14 d), bacteremia (15.94%), respiratory tract infection (7.74%), and urinary tract infection (7.71%) were predominant. Drug sensitivity analysis showed that P. aeruginosa was sensitive to enzymatic penicillins, third- and fourth-generation cephalosporins, and carbapenems. Acinetobacter baumannii and Klebsiella pneumoniae were sensitive only to tigecycline; Staphylococcus epidermidis and Enterococcus faecium were highly sensitive to linezolid, tigecycline, and vancomycin.
In this study, we identified the timing, the common species, and site of infection in patients with NP.
Core tip: In our study, Gram-negative bacteria were the main pathogens in necrotizing pancreatitis patients with infectious complications in our hospital. The most common Gram-negative bacteria were Escherichia coli and Pseudomonas aeruginosa. Additionally, the proportion of multidrug-resistant bacteria was relatively large, and caution should be used in the application of antibiotics. The extrapancreatic infection time was usually earlier than that of pancreatic infection. For patients with suspected infection, blood and respiratory pathogens should be cultured first. Third- or fourth-generation cephalosporins or carbapenems can be used as empirical drugs. Persistent organ failure, multidrug resistance, and multiple operations were risk factors for death.