重症急性胰腺炎合并腹腔感染患者病原菌分布、药物敏感性分析及其院内死亡的危险因素探讨

摘要 目的：观察重症急性胰腺炎（SAP）合并腹腔感染（IAI）患者病原菌分布，分析药物敏感性，同时探讨其院内死亡的危险因素。方法：本研究纳入2017年1月~2022年1月期间来解放军联勤保障部队第九二二医院接受治疗并确诊的SAP合并IAI患者100例，采集患者腹水标本，观察其病原菌分布，分析药物敏感性。入院后收集患者人口学特征、实验室检查等资料，探讨患者院内死亡的危险因素。结果：100例SAP合并IAI患者腹水标本中，分离出186株病原菌，其中革兰阴性菌有108株，占比58.06%。革兰阳性菌51株，占比27.42%。真菌27株，占比14.52%。鲍曼不动杆菌对不同抗菌药物的敏感性均较低，大肠埃希菌对厄他培南、亚胺培南、哌拉西林／他唑巴坦、庆大霉素、美罗培南的敏感性较高，肺炎克雷伯菌对亚胺培南、美罗培南的敏感性较高，葡萄球菌属对替加环素、万古霉素、利奈唑胺的敏感性较高，屎肠球菌对替加环素、利奈唑胺的敏感性较高，粪肠球菌对氨苄西林、万古霉素、环丙沙星、替加环素的敏感性较高。单因素分析显示，SAP合并IAI患者院内死亡与器官障碍数目、膀胱压、入院时急性生理学与慢性健康状况评分（APACHE II）评分、白细胞计数（WBC）、血钙、红细胞压积（HCT）、总胆固醇（TC）、甘油三醋（TG）、降钙素原（PCT）、C反应蛋白（CRP）、动脉二氧化碳分压（PaCO₂）、动脉氧分压（PaO2）有关（P<0.05）。多因素Logistic回归分析结果显示：器官障碍数目偏多、血钙偏低、CRP偏高、APACHE II评分偏高、膀胱压偏高、PaO₂偏低、WBC偏高是导致SAP合并IAI患者院内死亡的危险因素（P<0.05）。结论：SAP合并IAI患者病原菌分布以革兰阴性菌为主，主要的革兰阴性菌、革兰阳性菌耐药率高。此外，器官障碍数目偏多、血钙偏低、CRP偏高、APACHE II评分偏高、膀胱压偏高、PaO₂偏低、WBC偏高是影响SAP合并IAI患者院内死亡的危险因素。

Pathogenic Bacteria Distribution, Drug Sensitivity Analysis and Risk Factors of Hospital Death in Patients with Severe Acute Pancreatitis Complicated with Intra-Abdominal Infection

ABSTRACT Objective: To observe the pathogenic bacteria distribution in patients with severe acute pancreatitis (SAP) complicated with intra-abdominal infection (IAI), and to analyze the drug sensitivity, and explore the risk factors of hospital death. Methods: In this study, 100 patients with SAP complicated with IAI who received treatment and were diagnosed in The 922 Hospital of the Joint Service Support Force of the People''s Liberation Army from January 2017 to January 2022 were included. Ascites samples were collected, the pathogenic bacteria distribution was observed, and drug sensitivity was analyzed. After admission, demographic characteristics, laboratory examination and other data of patients were collected, and the risk factors of hospital death were explored. Results: 186 strains of pathogenic bacteria were isolated from 100 ascites samples of patients with SAP complicated with IAI, included 108 strains of gram-negative bacteria, accounting for 58.06%. 51 strains of gram-positive bacteria, accounting for 27.42%. 27 strains of fungus, accounting for 14.52%. Acinetobacter baumannii is less sensitive to different antimicrobial agents. Escherichia coli is more sensitive to ertapenem, imipenem, piperacillin/tazobactam, gentamicin, meropenem, Klebsiella pneumoniae is more sensitive to imipenem and meropenem, Staphylococcus is more sensitive to tegacyclin, vancomycin, and linezolid, and Enterococcus faecium is highly sensitive to tegacyclin and linezolid, and Enterococcus faecalis is highly sensitive to ampicillin, vancomycin, ciprofloxacin and tegacyclin. Univariate analysis showed that the hospital deaths patients with SAP complicated with IAI were related to the number of organ disorders, bladder pressure, acute physiology and chronic health score (APACHE II) at admission, white blood cell count (WBC), blood calcium, hematocrit HCT), total cholesterol (TC), triglyceride (TG), procalcitonin (PCT), C-reactive protein (CRP), arterial carbon dioxide partial pressure (PaCO₂) and arterial oxygen partial pressure (PaO2) (P<0.05). The results of multivariate Logistic regression analysis showed that more number of organ disorders, lower blood calcium, higher CRP, higher APACHE II score, higher bladder pressure, lower PaO₂, and higher WBC were the risk factors for hospital death (P<0.05). Conclusion: The pathogenic bacteria in patients with SAP complicated with IAI are mainly gram-negative bacteria, and the main gram-negative bacteria and gram-positive bacteria has high drug resistance rate. In addition, more number of organ disorders, lower blood calcium, higher CRP, higher APACHE II score, higher bladder pressure, lower PaO₂, and higher WBC are risk factors for hospital death in patients with SAP complicated with IAI.