急性胰腺炎患者腹腔感染病原菌分布及危险因素分析
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摘要
目的分析急性胰腺炎(AP)患者腹腔感染病原菌分布及引发感染的相关危险因素。方法收集2015年5月至2018年2月该院收治的100例AP患者资料,其中26例重症急性胰腺炎(SAP)并发腹腔感染作为观察组,74例未发生腹腔感染者作为对照组。对比两组的基本情况、炎性介质分布、胰腺损伤程度、病原菌分布特点及引发腹腔感染的相关危险因素。结果两组性别、年龄、发病类型、禁食时间、呼吸衰竭比较,差异均无统计学意义(P>0.05);观察组的48h内急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、肾衰竭比例显著高于对照组,差异均有统计学意义(P<0.05)。观察组白细胞(WBC)、中性粒细胞(N)、C反应蛋白(CRP)显著高于对照组,差异均有统计学意义(P<0.05)。两组血淀粉酶水平比较差异无统计学意义(P>0.05)。该研究共分离出57株病原菌,其中革兰阴性菌是造成观察组腹腔感染的主要病原菌。革兰阴性菌均以肺炎克雷伯菌、阴沟肠杆菌为主;革兰阳性菌以金黄色葡萄球菌、屎肠球菌为主。两组革兰阴性菌、革兰阳性菌、真菌分布比较,差异均无统计学意义(P>0.05)。经logistic回归分析,肾衰竭、WBC、N、CRP是SAP患者腹腔感染的独立危险因素(P<0.05)。结论 AP患者合并腹腔感染与多种因素相关,临床应积极采取措施,提高治疗的有效性。
Objective To investigate the pathogens and risk factors for abdominal infections in patients with acute pancreatitis(AP).Methods The data of 100 AP patients in a hospital from May 2015 to february 2018 were collected and analyzed,including basic conditions,distribution of inflammatory mediators,extent of pancreatic injury,distribution characteristics of the original bacteria,and associated risk factors.Among them,26 cases of severe acute pancreatitis(SAP)complicated with abdominal infections were set as observation group,and 74 cases without abdominal infection were included into control group.Results The gender,age,onset type,fasting time and respiratory failure of two groups had no significant difference(P>0.05);The APACHE Ⅱscores and renal failure percentage within the 48 hof the observation group were higher than those of the control group(P<0.05);The WBC,N,and CRP in observation group were significantly higher than those in the control group(P<0.05);No difference was found in the AMS levels(P>0.05);A total of 57 strains of pathogens were isolated,of which gram-negative bacteria were the main pathogens causing the abdominal infection in the observation group.Gram-negative bacteria were mainly Klebsiellapneumoniae and Enterobacter cloacae;Gram-positive bacteria were Staphylococcus aureus and Enterococcus faecium.No significant difference was found in the distribution of Gram-negative bacteria,Gram-positive bacteria and fungi between two groups(P>0.05);Logistic regression analysis showed that renal failure,WBC,N,and CRP were independent risk factors for abdominal infection in SAP patients(P<0.05).Conclusion Abdominal infections in AP patients are associated with a variety of factors.Clinical measures should be actively taken to improve the effectiveness of treatment.
Objective To investigate the pathogens and risk factors for abdominal infections in patients with acute pancreatitis(AP).Methods The data of 100 AP patients in a hospital from May 2015 to february 2018 were collected and analyzed,including basic conditions,distribution of inflammatory mediators,extent of pancreatic injury,distribution characteristics of the original bacteria,and associated risk factors.Among them,26 cases of severe acute pancreatitis(SAP)complicated with abdominal infections were set as observation group,and 74 cases without abdominal infection were included into control group.Results The gender,age,onset type,fasting time and respiratory failure of two groups had no significant difference(P>0.05);The APACHE Ⅱscores and renal failure percentage within the 48 hof the observation group were higher than those of the control group(P<0.05);The WBC,N,and CRP in observation group were significantly higher than those in the control group(P<0.05);No difference was found in the AMS levels(P>0.05);A total of 57 strains of pathogens were isolated,of which gram-negative bacteria were the main pathogens causing the abdominal infection in the observation group.Gram-negative bacteria were mainly Klebsiellapneumoniae and Enterobacter cloacae;Gram-positive bacteria were Staphylococcus aureus and Enterococcus faecium.No significant difference was found in the distribution of Gram-negative bacteria,Gram-positive bacteria and fungi between two groups(P>0.05);Logistic regression analysis showed that renal failure,WBC,N,and CRP were independent risk factors for abdominal infection in SAP patients(P<0.05).Conclusion Abdominal infections in AP patients are associated with a variety of factors.Clinical measures should be actively taken to improve the effectiveness of treatment.
引文
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[11]成燕,范炜,杨薇,等.41例急性重症胰腺炎患者合并腹腔感染的危险因素分析[J].检验医学与临床,2017,14(14):2048-2050.
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[14]金光军,张浙恩,厉有名.重症急性胰腺炎合并腹腔感染的感染特点和相关因素分析[J].中国微生态学杂志,2017,29(1):85-88.
[15]杨慧明,杨双汇,黄耿文.急性坏死性胰腺炎合并感染的病原菌及耐药性分析[J].中国普通外科杂志,2015,24(9):1285-1288.
[2]杨科,杨启,秦长岭.急性重症胰腺炎患者腹腔感染的临床诊断及治疗[J].中华医院感染学杂志,2015,20(5):1122-1124.
[3]FARKAS J,TISZLAVICZ Z,TAKACS T A,et al.Analysis of plasma levels and polymorphisms of S100A8/9and S100A12in patients with acute pancreatitis[J].Pancreas,2014,43(3):485-487.
[4]夏书香,朴艺花,黄媛,等.急性重症胰腺炎患者腹腔感染病原菌分布与药敏分析[J].中华医院感染学杂志,2016,26(9):2053-2055.
[5]ZHAO X L,ZHU S F,XUE G J,et al.Early oral refeeding based on hunger in moderate and severe acute pancreatitis:aprospective controlled,randomized clinical trial[J].Nutrition,2015,31(1):171-175.
[6]赵宁.重症急性胰腺炎诊治进展[J].中国热带医学,2003,3(1):67-68.
[7]王春友,李非.急性胰腺炎诊治指南(2014)[J].浙江医学,2015,14(1):7-10.
[8]何清,陈燕涛,钟贵芳,等.联合替加环素的抗菌治疗在重症急性胰腺炎多药耐药菌腹腔感染中的应用[J].中华普通外科杂志,2016,31(1):59-60.
[9]SCHWENDER B J,GORDON S R,GARDNER T B.Risk factors for the development of Intra-Abdominal fungal infections in acute pancreatitis[J].Pancreas,2015,44(5):805-807.
[10]曾雪云,毛兴龙,钱军,等.重症急性胰腺炎伴腹腔感染患者易感因素分析[J].中华医院感染学杂志,2016,26(18):4173-4175.
[11]成燕,范炜,杨薇,等.41例急性重症胰腺炎患者合并腹腔感染的危险因素分析[J].检验医学与临床,2017,14(14):2048-2050.
[12]LIU C N,CHEN S,ZHAO Y,et al.Life-threatening complications of acute pancreatitis[J].Intensive Care Med,2015,41(6):1145-1146.
[13]吕国龄,霍正禄.重症急性胰腺炎患者腹腔感染的危险因素分析[J].中国临床研究,2017,30(6):793-795.
[14]金光军,张浙恩,厉有名.重症急性胰腺炎合并腹腔感染的感染特点和相关因素分析[J].中国微生态学杂志,2017,29(1):85-88.
[15]杨慧明,杨双汇,黄耿文.急性坏死性胰腺炎合并感染的病原菌及耐药性分析[J].中国普通外科杂志,2015,24(9):1285-1288.