Objective: To investigate the prognostic factors of multi-drug resistant organism (MDRO) infection in patients with infected pancreatic necrosis(IPN). Methods: A retrospective study was performed to assess the MDRO in IPN patients. The clinical data of 104 IPN patients admitted to the Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from June 2013 to January 2019 were analyzed. Fifty-six patients were allocated in the MDRO group and 48 patients in the non-MDRO group depended on drug sensitivity test. There were 37 males and 19 females in the MDRO group with age of 40 (23) years. The duration time was 3(5) days between onset and admission. In the non-MDRO group,34 males and 14 females were included with age of (42±14)years. The duration time was 3(4) days between onset and admission. Normally distributed quantitative variables was represented by x±s, non-normally distributed quantitative variables was represented by M(Q(R)). Wilcoxon rank-sum test and χ(2) test were used to analyze the data. Univariate and multivariable Logistic regression analytic model were used to figure out the risk factors associated with MDRO infection. Results: The mean duration of hospital stay was 29.5(31.8) days and hospitalization expenses were CNY 166 991(270 692), which were much higher than those in non-MDRO group (16.5(15.7) days, 56 789(62 354) yuan) (W=1 889, 2 019, both P<0.01). Gram-negative isolates(67.2%, 80 /119) were commonly detected in IPN patients. Acinetobacter baumannii was the most common MDRO(27.0%,20/74). Initial use of carbapenem(OR=2.22, 95%CI: 1.02-4.96, P=0.047) and open necrosectomy(OR=10.00, 95%CI: 3.14-44.77, P<0.01) were the potential risk factors for MDRO-induced infections in IPN. Furthermore, the Logistic regression analysis revealed that open necrosectomy is the independent variable for MDRO infections (OR=9.42, 95%CI: 2.92-42.42, P<0.01). Conclusion: Open necrosectomy was the independent risk factor for the infection of MDRO.
目的： 探讨感染性胰腺坏死（IPN）患者发生多重耐药菌（MDRO）感染的预后因素。方法： 回顾性收集2013年6月至2019年1月哈尔滨医科大学附属第一医院胰胆外科收治的104例IPN患者的临床资料。根据药物敏感试验结果分为MDRO组（56例）和非MDRO组（48例）。MDRO组中男性37例，女性19例，年龄40（23）岁，发病至就诊时间为3(5) d；非MDRO组中男性34例，女性14例，年龄（42±14）岁，发病至就诊时间为3(4) d。符合正态分布的计量资料以x±s表示，非正态分布的计量资料以M（Q(R)）表示；采用Wilcoxon秩和检验和χ(2)检验进行分析；使用Logistic回归模型进行预后因素分析。结果： MDRO组患者住院时间为29.5(31.8) d、医疗费用166 991（270 692）元，与非MDRO组[16.5(15.7) d、56 789（62 354）元]相比差异均有统计学意义（W=1 889、2 019，P值均<0.01）。革兰阴性杆菌是IPN患者常见致病菌（67.2%，80/119），鲍曼不动杆菌是最常见的多重耐药菌（27.0%，20/74）。应用碳青霉烯类药物（OR=2.22，95 %CI：1.02~4.96，P=0.047）、开放坏死组织清除术（OR= 10.00 ，95 %CI ：3.14~44.77，P<0.01）是IPN患者感染MDRO的预后因素。进一步回归分析结果表明，实施开放坏死组织清除术是SAP患者发生MDRO感染的独立预后因素（OR=9.42，95 %CI：2.92~42.42 ，P<0.01）。结论： 开放坏死组织清除术是IPN患者MDRO感染的独立预后因素。.
Keywords: Acinetobacter baumannii; Infected pancreatic necrosis; Infection; Multi-drug resistant organism; Pancreatitis, acute necrotizing.