Predictors of Mortality and Drug Resistance Among Carbapenem-Resistant Enterobacteriaceae-Infected Pancreatic Necrosis Patients.

Wu, Di ORCID: 0000-0002-5622-7488, Xiao, Jie, Ding, Junjie, Jia, Yan ORCID: 0000-0003-1048-9842, Guo, Zimeng, Liu, Huanmiao and Peng, Jie (2021) Predictors of Mortality and Drug Resistance Among Carbapenem-Resistant Enterobacteriaceae-Infected Pancreatic Necrosis Patients. Infectious diseases and therapy, 10 (3). pp. 1665-1676.

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Official URL: http://dx.doi.org/10.1007/s40121-021-00489-5

Abstract

<h4>Introduction</h4>Carbapenem-resistant Enterobacteriaceae (CRE) has emerged as a global threat to hospitalization patients. Infected pancreatic necrosis (IPN) leads to high risks of CRE infections with increasing mortality. Our study aims to determine the predictors related to 90-day overall mortality of CRE IPN.<h4>Methods</h4>We retrospectively reviewed the drug resistance rates and clinical characteristics of CRE IPN patients from January 1, 2016, to January 1, 2021. Independent predictors of mortality were identified via univariate and multivariate analyses.<h4>Results</h4>During the 5-year period, 75 IPN patients suffered from 135 episodes of CRE infections with mortality up to 50.7%. CRE strains were highly resistant (> 50%) to nine of ten common antibiotics, except tigecycline (18%). The most common pathogen was carbapenem-resistant Klebsiella pneumoniae (84 of 135). Lung was the main site of extrapancreatic infections, followed by bloodstream and biliary tract. The independent predictors of mortality were Sequential Organ Failure Assessment (SOFA) score > 2 (hazard ratio 3.746, 95% confidence interval 1.209-11.609, P = 0.022) and procalcitonin > 6 ng/l (hazard ratio 2.428, 95% confidence interval 1.204-4.895, P = 0.013).<h4>Conclusion</h4>CRE is widespread as a global challenge with a high mortality rate among IPN patients due to limited therapeutic options. Carbapenem-resistant K. pneumoniae is the leading category of CRE which requires more attention in clinical practice. High SOFA score and procalcitonin level represent two independent predictors of mortality in CRE IPN patients. Greater efforts are needed toward timely therapeutic intervention for CRE IPN.

Item Type:	Article
Uncontrolled Keywords:	Acute pancreatitis, Carbapenem-resistant Enterobacteriaceae, Drug resistance, Infected pancreatic necrosis, Mortality, Predictor
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User:	Symplectic Admin
Date Deposited:	17 Mar 2023 11:37
Last Modified:	18 Mar 2024 04:10
DOI:	10.1007/s40121-021-00489-5
Open Access URL:	https://doi.org/10.1007/s40121-021-00489-5
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3169145