Predictors of mortality in acute pancreatitis complicated with multidrug-resistant Klebsiella pneumoniae infection

Abstract

Background Multidrug-resistant (MDR) Klebsiella pneumoniae infections, from pancreatic infections to bloodstream infections, influence the mortality of patients with acute pancreatitis (AP) on the condition of limited antibiotic choices. The aim of this study was to investigate the predictor of mortality among AP patients complicated with MDR-K. pneumoniae infections. Methods Seventy-one AP patients who occurred MDR-K. pneumoniae infections from August 1st, 2016 to August 1st, 2020 were enrolled. MDR-K. pneumoniae was defined as the K. pneumoniae strain non-susceptible to at least one agent in three or more antimicrobial categories. MDR-K. pneumoniae isolates were confirmed by Vitek-2 system. Antibiotic susceptibility test was carried out using a micro broth dilution method. Clinical characteristics and drug-resistance rates were retrospectively reviewed, and the predictors of mortality were evaluated by univariate and multivariate analyses. Results The mortality rate of AP patients complicated with MDR-K. pneumoniae infections reached 46.5% (33 of 71), and pancreas (n = 53) was the most common site of MDR-K pneumoniae strains. The drug resistance rates of MDR-K. pneumoniae were high to 11 of 12 common antibiotics (more than 50.0%) except of tigecycline (23.9%). The predictor independently associated with mortality was septic shock (hazard ratio 2.959, 95% confidence intervals 1.396 – 6.272, P = 0.005). Conclusions More attention should be paid for pancreatic MDR-K. pneumoniae infections among AP patients The predictor for mortality of AP patients complicated with MDR-K. pneumoniae infection is septic shock. Therefore, further clinical investigations should focus on areas against septic shock.

Risk Factors for Mortality Among Critical Acute Pancreatitis Patients with Carbapenem-Resistant Organism Infections and Drug Resistance of Causative Pathogens

“…Similar to previous research, our study showed that CRO are highly resistant to most common antibiotics, which may be attributed to the clinical use of wholly prophylactic antibiotic prescription [ 17 , 31 ]. The vast majority of CAP patients received antibiotics before the IPN intervention because of suspected infections with possible manifestations.…”

Impact of multiple drug-resistant Gram-negative bacterial bacteraemia on infected pancreatic necrosis patients

“…In line with Li et al., hyperlipidaemia was the primary aetiology in the IPN patients, but it was interesting that the biliary aetiology was more frequent in patients within the MDR-GNB bacteraemia group than the contrast group, thus suggesting that MDR-GNB bacteraemia could be secondary to bacterial translocation through the gut ( Flint and Windsor, 2003 ; Li et al., 2020 ; Yang and McNabb-Baltar, 2020 ). In addition, these invasive treatments may result in bacteraemia, especially MDR-GNB bacteraemia ( Wu et al., 2021b ). In our study, there were also 12 of 24 patients diagnosed with bacteraemia during the post-intervention (≤5 days), which may be possibly related to translocation secondary to intervention and needs to be validated in the larger sample size study.…”

“…Gram-positive bacterial or fungal infections were defined as the presence of concomitant infections ( Wu et al., 2022b ). MDR- GNB is defined as strains not sensitive to three or more categories of antibiotics ( Wu et al., 2021b ). Combination antibiotic therapy was defined as a regimen with at least two categories of antibiotics based on the condition of patients and approved by infectious disease specialists.…”

Whole-Genome Sequencing and Comparative Genomics Analysis of a Newly Emerged Multidrug-Resistant Klebsiella pneumoniae Isolate of ST967

“…A recent survey conducted in 41 countries by the Central Asian and the European Surveillance of Antimicrobial Resistance network ( 11 ) revealed that >50% of the isolates recovered from patients (predominantly in Southern and Eastern Europe) were resistant to third-generation cephalosporins and >25% were resistant to carbapenems. Moreover, mortality rates caused by MDR K. pneumoniae have been reported to be as high as 50% or higher in clinical settings ( 12 , 13 ). This is further exacerbated by new emerging clones, such as sequence types 101 (ST101), ST307, and ST147, which have acquired virulence factors and antimicrobial resistance (AMR) genes, contributing to their success as persistent nosocomial infections ( 14 , 15 ).…”