Introduction

Carbapenem-resistant Enterobacteriaceae (CRE) has emerged as a global threat to hospitalization patients. Infected pancreatic necrosis (IPN) leads to high risks of CRE infections with increasing mortality. Our study aims to determine the predictors related to 90-day overall mortality of CRE IPN.

Methods

We retrospectively reviewed the drug resistance rates and clinical characteristics of CRE IPN patients from January 1, 2016, to January 1, 2021. Independent predictors of mortality were identified via univariate and multivariate analyses.

Results

During the 5-year period, 75 IPN patients suffered from 135 episodes of CRE infections with mortality up to 50.7%. CRE strains were highly resistant (> 50%) to nine of ten common antibiotics, except tigecycline (18%). The most common pathogen was carbapenem-resistant Klebsiella pneumoniae (84 of 135). Lung was the main site of extrapancreatic infections, followed by bloodstream and biliary tract. The independent predictors of mortality were Sequential Organ Failure Assessment (SOFA) score > 2 (hazard ratio 3.746, 95% confidence interval 1.209–11.609, P = 0.022) and procalcitonin > 6 ng/l (hazard ratio 2.428, 95% confidence interval 1.204–4.895, P = 0.013).

Conclusion

CRE is widespread as a global challenge with a high mortality rate among IPN patients due to limited therapeutic options. Carbapenem-resistant K. pneumoniae is the leading category of CRE which requires more attention in clinical practice. High SOFA score and procalcitonin level represent two independent predictors of mortality in CRE IPN patients. Greater efforts are needed toward timely therapeutic intervention for CRE IPN.

中文翻译：

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碳青霉烯类耐药肠杆菌科感染胰腺坏死患者死亡率和耐药性的预测因素

介绍

耐碳青霉烯类肠杆菌科细菌(CRE) 已成为对住院患者的全球威胁。感染性胰腺坏死 (IPN) 导致 CRE 感染的高风险和死亡率增加。我们的研究旨在确定与 CRE IPN 90 天总体死亡率相关的预测因子。

方法

我们回顾性分析了 2016 年 1 月 1 日至 2021 年 1 月 1 日 CRE IPN 患者的耐药率和临床特征。通过单变量和多变量分析确定了死亡率的独立预测因素。

结果

在 5 年期间，75 名 IPN 患者发生 135 次 CRE 感染，死亡率高达 50.7%。CRE 菌株对十种常见抗生素中的九种具有高度耐药性（> 50%），除了替加环素（18%）。最常见的病原体是耐碳青霉烯类肺炎克雷伯菌（135 个中的 84 个）。肺是胰腺外感染的主要部位，其次是血流和胆道。死亡率的独立预测因子是序贯器官衰竭评估 (SOFA) 评分 > 2（风险比 3.746，95% 置信区间 1.209-11.609，P  = 0.022）和降钙素原 > 6 ng/l（风险比 2.428，95% 置信区间 1.204 –4.895，P  = 0.013）。

结论

由于治疗选择有限，CRE 作为一项全球性挑战广泛存在，IPN 患者的死亡率很高。耐碳青霉烯类肺炎克雷伯菌是 CRE 的主要类别，在临床实践中需要更多关注。高 SOFA 评分和降钙素原水平代表 CRE IPN 患者死亡率的两个独立预测因子。需要加大力度对 CRE IPN 进行及时的治疗干预。