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Infectious Complications in Severe Acute Pancreatitis: Pathogens, Drug Resistance, and Status of Nosocomial Infection in a University-Affiliated Teaching Hospital

  • Hao Tian
  • Lang Chen
  • XingDa Wu
  • FuXing Li
  • Yi Ma
  • YiTong Cai
  • ShaoWei SongEmail author
Original Article

Abstract

Background

Secondary infection is an important factor affecting mortality and quality of life in patients with severe acute pancreatitis. The characteristics of secondary infection, which are well known to clinicians, need to be re-examined in detail, and their understanding among clinicians needs to be updated accordingly.

Aim

This study aims to investigate the characteristics and drug resistance of pathogens causing severe acute pancreatitis (SAP) secondary infection, to objectively present infection situation, and to provide reference for improved clinical management.

Methods

A retrospective analysis was performed on 55 consecutive patients with SAP who developed secondary infection with an accurate evidence of bacterial/fungal culture from 2016 to 2018. The statistics included the spectrum and distribution of pathogens, the drug resistance of main pathogens, and associations between multiple infectious parameters and mortality.

Results

A total of 181 strains of pathogens were isolated from (peri)pancreas; bloodstream; and respiratory, urinary, and biliary systems in 55 patients. The strains included 98 g-negative bacteria, 58 g-positive bacteria, and 25 fungi. Bloodstream infection (36.5%) was the most frequent infectious complication, followed by (peri)pancreatic infection (32.0%). Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Stenotrophomonas maltophilia were predominant among gram-negative bacteria. Gram-positive bacterial infections were mainly caused by Enterococcus faecium and Staphylococcus spp. Fungal infections were predominantly caused by Candida spp. The drug resistance of pathogens causing SAP secondary infection was generally higher than the surveillance level. Patients in the death group were older (55 ± 13 years vs. 46 ± 14 years; p = 0.039) and had longer intensive care unit (ICU) stay (14 vs. 8; p = 0.026) than those in the survival group. A. baumannii infection (68.4% vs. 33%; p = 0.013), number of pathogens ≥ 4 (10 vs. 6; p = 0.005), pancreatic infection (14 vs. 15, p = 0.024), and urinary infection (8 vs. 5; p = 0.019) were significantly associated with mortality.

Conclusion

Gram-negative bacteria are the main pathogens causing SAP secondary infection, in which nosocomial infections play a major role. The drug resistance profile of gram-negative bacteria is seriously threatening, and the commonly used antibiotics in SAP are gradually losing their effectiveness. Much attention should be paid to the rational use of antibiotics, and strategies should be established for infection prevention in SAP.

Keywords

Severe acute pancreatitis Secondary infection Nosocomial infection Microbiology Drug resistance 

Notes

Acknowledgments

We thank Dr. Ming Ma from Clinical Laboratory Department of the First Affiliated Hospital of China Medical University for his microbiological consultation in this study.

Compliance with Ethical Standards

Conflicts of interest

The authors declare that they have no conflicts of interest related to this work.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Hao Tian
    • 1
  • Lang Chen
    • 1
  • XingDa Wu
    • 1
  • FuXing Li
    • 1
  • Yi Ma
    • 2
  • YiTong Cai
    • 3
  • ShaoWei Song
    • 1
    Email author
  1. 1.Department of Pancreatic and Biliary SurgeryThe First Affiliated Hospital of China Medical UniversityShenyangChina
  2. 2.Department of Thoracic SurgeryThe First Affiliated Hospital of China Medical UniversityShenyangChina
  3. 3.Department of EndocrinologyThe First Affiliated Hospital of China Medical UniversityShenyangChina

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