Adverse clinical outcomes associated with multidrug-resistant organisms in patients with infected pancreatic necrosis

Abstract

BackgroundMultidrug-resistant organisms (MDROs) is becoming a serious worldwide threat to public health. However, the impact of MDROs on the outcomes of the patients with infected pancreatic necrosis (IPN) remains unclear. This study aims to evaluate the roles of MDROs in IPN. MethodsA prospectively maintained database of 188 patients with IPN between January 2010 and May 2019 was analyzed. The microbiology profile of organisms isolated from wall-off necrosis (WON) was specifically investigated to correlate with the outcomes of the patients. ResultsOf the 188 patients with IPN, 108 patients (57.4%) had MDROs detected in aspirates from WON. Carbapenem-resistant Klebsiella pneumoniae (CRKP) accounted for 43.5% of the MDROs isolated (60/138), followed by Carbapenem-resistant Acinetobacter baumanii (CRAB) (34.8%, 48/138) and Escherichia coli producing an extended-spectrum beta-lactamase (ESBLp) (6.5%, 9/138). MDROs infection was associated with higher mortality (35.2% vs 11.3%, P < 0.001), higher rate of hemorrhage (36.1% vs 11.3%, P < 0.001), longer intensive care unit (ICU) stay (23 vs 12 days, P < 0.001), longer hospital stay (68 vs 51 days, P = 0.001) and more hospitalization expenses (45,190 ± 31,680 vs 26,965 ± 17,167 $, P < 0.001). Multivariate analysis of predictors of mortality indicated that MDROs infection (OR = 2.6; 95% confidence interval [CI], 1.0–6.5; P = 0.042), age ≥ 50 years (OR = 2.6; 95% CI, 1.2–5.8; P = 0.016), severe category (OR = 2.9; 95% CI, 1.1–8.0; P = 0.035), bloodstream infection (OR = 3.4; 95% CI, 1.5–7.6; P = 0.049), step-down surgical approach (OR = 2.7; 95% CI, 1.1–6.2; P = 0.023) were significant factors. ConclusionsMDROs infection was prevalent among patients with IPN and associated with adverse clinical outcomes and increased mortality.