Clinical relationship between carbapenem-resistant Klebsiella pneumoniae infection and the severity of acute pancreatitis / 中华消化外科杂志

ABSTRACT

Objective:To investigate the clinical relationship between carbapenem-resis-tant Klebsiella pneumoniae (CRKP) infection and the severity of acute pancreatitis. Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 109 patients with acute pancreatitis who were admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from January 2017 to January 2018 were collected. There were 66 males and 43 females, aged (48±17)years. Blood, body fluid or anal swab samples of patients were collected aseptically. Patients were treated with gallbladder puncture and drainage, nasobiliary drainage, surgical debridement, computed tomography (CT) guided interventional drainage or conservative treatment, respectively, after being comprehensively diagnosed. Observation indicators (1) severity of acute pancreatitis and results of CRKP infection test; (2) diagnostic value of CRKP infection for severity of acute pancreatitis; (3) treatment of acute pancreatitis; (4) prognosis of patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Spearman correlation analysis were performed for correlation analyses. The receiver operating characteristic (ROC) curve was conducted to evaluate the diagnostic value. Results:(1) Severity of acute pancreatitis and results of CRKP infection test of 109 patients, there were 37 cases with mild acute pancreatitis, 8 cases with moderate-severe acute pancreatitis, 64 cases with severe acute pancreatitis. There were 45 cases with mild disease and 64 cases with severe disease, 48 cases with CRKP infection and 61 cases without CRKP infection. There were 3 cases and 45 cases with CRKP infection in the 45 mild disease cases and 64 severe disease cases, respectively, showing a significant difference ( χ2=43.430, P<0.05). Result of Pearson correlation analysis showed that CRKP infection was positively correlated with the severity of acute pancreatitis ( r=0.631, P<0.05). The duration of hospital stay were (66±6)days and (24±3)days for the cases with CRKP infection and cases without CRKP infection, respectively, showing a significant difference ( t=47.661, P<0.05). (2) Diagnostic value of CRKP infection for severity of acute pancrea-titis the area under the ROC curve, sensitivity, and specificity of CRKP infection for the diagnosis of SAP were 0.799 (95% confidence interval as 0.714?0.885, P<0.05), 0.688, and 0.911, respectively. (3) Treatment of acute pancreatitis of 109 patients, 17 cases underwent nasobiliary drainage, 19 cases underwent gallbladder puncture and drainage, 42 cases underwent surgical debridement, 48 cases underwent CT guided interventional drainage and 43 cases underwent conservative treatment. One patient may undergo multiple treatments. Of 109 patients, 66 patients underwent one and more invasive treatments with 47 cases undergoing CRKP infection and 43 patients did not undergo invasive treatment with 1 case undergoing CRKP infection, respectively, showing a significant difference ( χ2=50.134, P<0.05). (4) Prognosis of patients all 109 patients were followed up for 3?9 months, with a median follow-up time of 6 months. During the follow-up, there were 15 cases and 6 cases dead in the 48 cases with CRKP infection and the 61 cases without CRKP infection, respec-tively, showing a significant difference ( χ2=7.919, P<0.05). Conclusion:CRKP infec-tion is positively correlated with the severity of acute pancreatitis, and CRKP infection is associated with the duration of hospital stay and types of invasive treatments.