Effect of Multidrug Resistant Bacterial Infection in patients with Acute Necrotizing Pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WUHua-qiang ^1,2 , GUOQiang ¹ ,  HUWei-ming ¹

1. Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;
2. Department of Surgery, Fushun People's Hospital, Fushun 643200, Sichuan Province, China;

Corresponding author：

HUWei-ming, Email: huweiming64@gmail.com

Keywords：

Acute pancreatitis; Multidrug resistant bacteria; Infection

DOI：

10.7507/1007-9424.20150216

Video：

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Objective To investigate the effect of multidrug resistant (MDR) bacterial infection in clinical course of acute pancreatitis. Methods The medical records of 134 patients with a diagnosis of infected pancreatic necrosis in West China Hospital from Jan. 2003 to Jun. 2010 were reviewed. Results MDR microorganisms were found in 78 of the 134 patients. MDR group had higher rate of transferred patients than non-MDR group (38.5% vs. 10.7%, P=0.002). The intensive care unit admission rate was significantly higher in patients with MDR bacterial infections (48.7% vs. 26.8%, P=0.01). The mean intensive care unit stay was significantly longer in patients with MDR bacterial infections (20 days vs. 3 days, P<0.001). Mortality and total hospital stay was not significantly different in the patients with MDR infections vs. those without it (20.5% vs. 14.3%, P>0.05; 78 d vs. 55 d, P>0.05). Conclusion Clinicians should be aware of the high incidence and impact of MDR infections in patients with acute necrotizing pancreatitis, especially in transferred patients.

Citation： WUHua-qiang, GUOQiang, HUWei-ming. Effect of Multidrug Resistant Bacterial Infection in patients with Acute Necrotizing Pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(7): 836-839. doi: 10.7507/1007-9424.20150216 Copy

1.	Andersson B, Appelgren B, Sjödin V, et al. Acute pancreatitis-costs for healthcare and loss of production. Scand J Gastroenterol, 2013, 48(12):1459-1465.
2.	Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States:2012 update. Gastroenterology, 2012, 143(5):1179-1187.
3.	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012:revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1):102-111.
4.	Acevedo-Piedra NG, Moya-Hoyo N, Rey-Riveiro M, et al. Validation of the determinant-based classification and revision of the atlanta classification systems for acute pancreatitis. Clin Gastroenterol Hepatol, 2014, 12(2):311-316.
5.	Nawaz H, Mounzer R, Yadav D, et al. Revised Atlanta and determinant-based classification:application in a prospective cohort of acute pancreatitis patients. Am J Gastroenterol, 2013, 108(12):1911-1917.
6.	Petrov MS, Shanbhag S, Chakraborty M, et al. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology, 2010, 139(3):813-820.
7.	van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology, 2011, 141(4):1254-1263.
8.	Beger HG, Bittner R, Block S, et al. Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology, 1986, 91(2):433-438.
9.	De Waele JJ, Vogelaers D, Hoste E, et al. Emergence of antibiotic resistance in infected pancreatic necrosis. Arch Surg, 2004, 139(12):1371-1375.
10.	Gloor B, Muller CA, Worni M, et al. Pancreatic infection in severe pancreatitis:the role of fungus and multiresistant organisms. Arch Surg, 2001, 136(5):592-596.
11.	Schmid SW, Uhl W, Friess H, et al. The role of infection in acute pancreatitis. Gut, 1999, 45(2):311-316.
12.	Fritz S, Hackert T, Hartwig W, et al. Bacterial translocation and infected pancreatic necrosis in acute necrotizing pancreatitis derives from small bowel rather than from colon. Am J Surg, 2010, 200(1):111-117.
13.	Besselink MG, van Santvoort HC, Boermeester MA, et al. Timing and impact of infections in acute pancreatitis. Br J Surg, 2009, 96(3):267-273.
14.	Behrman SW, Bahr MH, Dickson PV, et al. The microbiology of secondary and postoperative pancreatic infections:implications for antimicrobial management. Arch Surg, 2011, 146(5):613-619.
15.	Noor MT, Radhakrishna Y, Kochhar R, et al. Bacteriology of infection in severe acute pancreatitis. JOP, 2011, 12(1):19-25.
16.	Bai Y, Gao J, Zou DW, et al. Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis:evidence from a meta-analysis of randomized controlled trials. Am J Gastroenterol, 2008, 103(1):104-110.
17.	Xu T, Cai Q. Prophylactic antibiotic treatment in acute necrotizing pancreatitis:results from a meta-analysis. Scand J Gastroenterol, 2008, 43(10):1249-1258.
18.	Jafri NS, Mahid SS, Idstein SR, et al. Antibiotic prophylaxis is not protective in severe acute pancreatitis:a systematic review and metaanalysis. Am J Surg, 2009, 197(6):806-813.
19.	Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology, 2013, 13(4 Suppl 2):1-15.
20.	Wu BU, Hwang JQ, Gardner TH, et al. Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol, 2011, 9(8):710-717.
21.	Du XJ, Hu WM, Xia Q, et al. Hydroxyethyl starch resuscitation reduces the risk of intra-abdominal hypertension in severe acute pancreatitis. Pancreas, 2011, 40(8):1220-1225.
22.	Mirtallo JM, Forbes A, McClave SA, et al. International consensus guidelines for nutrition therapy in pancreatitis. JPEN J Parenter Enteral Nutr, 2012, 36(3):284-291.
23.	Kumar A, Singh N, Prakash S, et al. Early enteral nutrition in severe acute pancreatitis:a prospective randomized controlled trial comparing nasojejunal and nasogastric routes. J Clin Gastroenterol, 2006, 40(5):431-434.
24.	Petrov MS, Loveday BP, Pylypchuk RD, et al. Systematic review and meta-analysis of enteral nutrition formulations in acute pancreatitis. Br J Surg, 2009, 96(11):1243-1252.
25.	Guo Q, Li A, Xia Q, et al. The role of organ failure and infection in necrotizing pancreatitis:a prospective study. Ann Surg, 2014, 259(6):1201-1207.

1. Andersson B, Appelgren B, Sjödin V, et al. Acute pancreatitis-costs for healthcare and loss of production. Scand J Gastroenterol, 2013, 48(12):1459-1465.
2. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States:2012 update. Gastroenterology, 2012, 143(5):1179-1187.
3. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012:revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1):102-111.
4. Acevedo-Piedra NG, Moya-Hoyo N, Rey-Riveiro M, et al. Validation of the determinant-based classification and revision of the atlanta classification systems for acute pancreatitis. Clin Gastroenterol Hepatol, 2014, 12(2):311-316.
5. Nawaz H, Mounzer R, Yadav D, et al. Revised Atlanta and determinant-based classification:application in a prospective cohort of acute pancreatitis patients. Am J Gastroenterol, 2013, 108(12):1911-1917.
6. Petrov MS, Shanbhag S, Chakraborty M, et al. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology, 2010, 139(3):813-820.
7. van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology, 2011, 141(4):1254-1263.
8. Beger HG, Bittner R, Block S, et al. Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology, 1986, 91(2):433-438.
9. De Waele JJ, Vogelaers D, Hoste E, et al. Emergence of antibiotic resistance in infected pancreatic necrosis. Arch Surg, 2004, 139(12):1371-1375.
10. Gloor B, Muller CA, Worni M, et al. Pancreatic infection in severe pancreatitis:the role of fungus and multiresistant organisms. Arch Surg, 2001, 136(5):592-596.
11. Schmid SW, Uhl W, Friess H, et al. The role of infection in acute pancreatitis. Gut, 1999, 45(2):311-316.
12. Fritz S, Hackert T, Hartwig W, et al. Bacterial translocation and infected pancreatic necrosis in acute necrotizing pancreatitis derives from small bowel rather than from colon. Am J Surg, 2010, 200(1):111-117.
13. Besselink MG, van Santvoort HC, Boermeester MA, et al. Timing and impact of infections in acute pancreatitis. Br J Surg, 2009, 96(3):267-273.
14. Behrman SW, Bahr MH, Dickson PV, et al. The microbiology of secondary and postoperative pancreatic infections:implications for antimicrobial management. Arch Surg, 2011, 146(5):613-619.
15. Noor MT, Radhakrishna Y, Kochhar R, et al. Bacteriology of infection in severe acute pancreatitis. JOP, 2011, 12(1):19-25.
16. Bai Y, Gao J, Zou DW, et al. Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis:evidence from a meta-analysis of randomized controlled trials. Am J Gastroenterol, 2008, 103(1):104-110.
17. Xu T, Cai Q. Prophylactic antibiotic treatment in acute necrotizing pancreatitis:results from a meta-analysis. Scand J Gastroenterol, 2008, 43(10):1249-1258.
18. Jafri NS, Mahid SS, Idstein SR, et al. Antibiotic prophylaxis is not protective in severe acute pancreatitis:a systematic review and metaanalysis. Am J Surg, 2009, 197(6):806-813.
19. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology, 2013, 13(4 Suppl 2):1-15.
20. Wu BU, Hwang JQ, Gardner TH, et al. Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol, 2011, 9(8):710-717.
21. Du XJ, Hu WM, Xia Q, et al. Hydroxyethyl starch resuscitation reduces the risk of intra-abdominal hypertension in severe acute pancreatitis. Pancreas, 2011, 40(8):1220-1225.
22. Mirtallo JM, Forbes A, McClave SA, et al. International consensus guidelines for nutrition therapy in pancreatitis. JPEN J Parenter Enteral Nutr, 2012, 36(3):284-291.
23. Kumar A, Singh N, Prakash S, et al. Early enteral nutrition in severe acute pancreatitis:a prospective randomized controlled trial comparing nasojejunal and nasogastric routes. J Clin Gastroenterol, 2006, 40(5):431-434.
24. Petrov MS, Loveday BP, Pylypchuk RD, et al. Systematic review and meta-analysis of enteral nutrition formulations in acute pancreatitis. Br J Surg, 2009, 96(11):1243-1252.
25. Guo Q, Li A, Xia Q, et al. The role of organ failure and infection in necrotizing pancreatitis:a prospective study. Ann Surg, 2014, 259(6):1201-1207.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of Multidrug Resistant Bacterial Infection in patients with Acute Necrotizing Pancreatitis

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