Risk factors and pathogen analysis of catheter-related bloodstream infection in patients with acute pancreatitis / 中华胰腺病杂志

ABSTRACT

Objective:To investigate the risk factors and pathogen distribution of catheter-related bloodstream infection (CRBSI) in patients with acute pancreatitis(AP).Methods:A retrospective analysis was performed on the clinical data of moderately severe acute pancreatitis (MSAP) & severe acute pancreatitis (SAP) patients with central venous catheter (CVC) insertion admitted in Department of Pancreatic Surgery, Renmin Hospital of Wuhan University from April 2017 to March 2019. Patients with CRBSI were 1∶1 matched to those without CRBSI based on age, gender, diabetes, blood transfusion, parenteral nutrition, the site of CVC insertion and duration of catheterization. Accompanying abdominal infection, a APACHEⅡ score≥20, early enteral nutrition and antibiotics were included for logistic regression analysis on the risk factors for the occurrence of CRBSI in MSAP and SAP patients, and pathogen distribution was also investigated.Results:A total of 352 patients were enrolled, and 39 patients had CRBSI with an incidence of 11.08%, 8.83 per 1 000 catheter days. Multivariate logistic regression demonstrated that accompanying abdominal infection( OR=1.69, 95% CI 1.20-2.23)and APACHEⅡ score≥20 ( OR=2.87, 95% CI 1.79-5.46)were independent risk factors for CRBSI. Early enteral nutrition( OR=0.81, 95% CI 0.43-0.96) was protective factor. A total of 43 pathogens were detected, which were mainly Gram negative organisms, accounting for 58.13% (25/43), and Klebsiella pneumoniae was the most common (44.2%, 19/43). The ratio of multi-drug resistant (MDR) organisms was high (67.4%, 29/43). Conclusions:Accompanying abdominal infection and APACHEⅡ score≥20 were independent risk factors for AP complicated with CRBSI, while early enteral nutrition was the protective factor. Pathogens were mainly Gram negative organisms, and MDR organisms should be paid special attention to.