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Chen S, Lai W, Song X, Lu J, Liang J, Ouyang H, Zheng W, Chen J, Yin Z, Li H, Zhou Y. The distribution and antibiotic-resistant characteristics and risk factors of pathogens associated with clinical biliary tract infection in humans. Front Microbiol 2024; 15:1404366. [PMID: 38784792 PMCID: PMC11112516 DOI: 10.3389/fmicb.2024.1404366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Biliary Infection in patients is a common and important phenomenon resulting in severe complications and high morbidity, while the distributions and drug resistance profiles of biliary bacteria and related risk factors are dynamic. This study explored the characteristics of and risk factors for biliary infection to promote the rational use of antibiotics in clinically. Methods Bacterial identification and drug susceptibility testing were completed using the Vitek 2 Compact analysis system. The distribution and antibiotic-resistant characteristics of 3,490 strains of biliary bacteria in patients at Nankai Hospital from 2019 to 2021 were analyzed using Whonet 5.6 and SPSS 26.0 software. We then retrospectively analyzed the clinical data and risk factors associated with 2,340 strains of Gram-negative bacilli, which were divided into multidrug-resistant bacteria (1,508 cases) and non-multidrug-resistant bacteria (832 cases) by a multivariate Cox regression model. Results and discussion A total of 3,490 pathogenic bacterial strains were isolated from bile samples, including 2,340 (67.05%) Gram-negative strains, 1,029 (29.48%) Gram-positive strains, and 109 (4.56%) fungal strains. The top five pathogenic bacteria were Escherichia coli, Klebsiella pneumoniae, Enterococcus faecium, Enterococcus faecalis, and Pseudomonas aeruginosa. The rate of Escherichia coli resistance to ciprofloxacin increased (p < 0.05), while the resistance to amikacin decreased (p < 0.05). The resistance of Klebsiella pneumoniae to cephalosporins, carbapenems, β-lactamase inhibitors, cephalases, aminoglycosides, and quinolones increased (p < 0.05), and the resistance of Pseudomonas aeruginosa to piperacillin, piperacillin/tazobactam, ticacillin/clavulanic acid, and amicacin declined significantly (p < 0.05). The resistance of Enterococcus faecium to tetracycline increased by year (p < 0.05), and the resistance of Enterococcus faecalis to erythromycin and high-concentration gentamicin declined (p < 0.05). Multivariate logistic regression analysis suggested that the administration of third- or fourth-generation cephalosporins was an independent risk factor for biliary infection. In summary, Gram-negative bacilli were the most common pathogenic bacteria isolated from biliary infection patients, especially Escherichia coli, and the rates and patterns of drug resistance were high and in constant flux; therefore, rational antimicrobial drug use should be carried out considering risk factors.
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Affiliation(s)
- Shayan Chen
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
- Central Laboratory, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Precision Medicine, Guangdong, China
| | - Wenbin Lai
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Xuejing Song
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
- Central Laboratory, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Precision Medicine, Guangdong, China
| | - Jiongtang Lu
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Jianxin Liang
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Hao Ouyang
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Weihua Zheng
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Jianjun Chen
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Zhenggang Yin
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Huimin Li
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Yong Zhou
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
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Yan J, Yilin H, Di W, Jie W, Hanyue W, Ya L, Jie P. A nomogram for predicting the risk of mortality in patients with acute pancreatitis and Gram-negative bacilli infection. Front Cell Infect Microbiol 2022; 12:1032375. [PMID: 36439207 PMCID: PMC9685314 DOI: 10.3389/fcimb.2022.1032375] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVE Gram-negative bacilli (GNB) are common pathogens of infection in severe acute pancreatitis (SAP), and their occurrence increases the mortality of SAP. Early identification of SAP severity and prognosis is of great significance to SAP treatment. This study explored risk factors for mortality in patients with SAP and GNB infection and established a model for early prediction of the risk of death in GNB-infected SAP patients. METHODS Patients diagnosed with SAP from January 1, 2016, to March 31, 2022, were included, and their baseline clinical characteristics were collected. Univariate logistic regression analysis was performed to screen for death related variables, and concurrently, a Boruta analysis was performed to identify potentially important clinical features associated with mortality. The intersection of the two results was taken for further multivariate logistic regression analysis. A logistic regression model was constructed according to the independent risk factor of death and then visualized with a nomogram. The performance of the model was further validated in the training and validation cohort. RESULTS A total of 151 patients with SAP developed GNB infections. Univariate logistic regression analysis identified 11 variables associated with mortality. The Boruta analysis identified 11 clinical features, and 4 out of 9 clinical variables: platelet counts (odds ratio [OR] 0.99, 95% confidence interval [CI] 0.99-1.00; p = 0.007), hemoglobin (OR 0.96, 95% CI 0.92-1; p = 0.037), septic shock (OR 6.33, 95% CI 1.12-43.47; p = 0.044), and carbapenem resistance (OR 7.99, 95% CI 1.66-52.37; p = 0.016), shared by both analyses were further selected as independent risk factors by multivariate logistic regression analysis. A nomogram was used to visualize the model. The model demonstrated good performance in both training and validation cohorts with recognition sensitivity and specificity of 96% and 80% in the training cohort and 92.8% and 75% in the validation cohort, respectively. CONCLUSION The nomogram can accurately predict the mortality risk of patients with SAP and GNB infection. The clinical application of this model allows early identification of the severity and prognosis for patients with SAP and GNB infection and identification of patients requiring urgent management thus allowing rationalization of treatment options and improvements in clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Peng Jie
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
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Risk Factors for Mortality Among Critical Acute Pancreatitis Patients with Carbapenem-Resistant Organism Infections and Drug Resistance of Causative Pathogens. Infect Dis Ther 2022; 11:1089-1101. [PMID: 35377132 PMCID: PMC9124255 DOI: 10.1007/s40121-022-00624-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/11/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Carbapenem-resistant organisms (CRO) have emerged as a major global public health threat, but their role in critical acute pancreatitis (CAP) is still not defined. Our study aims to investigate risk factors associated with mortality and drug resistance among CAP patients with CRO infection. Methods The clinical characteristics of CAP patients with CRO infection and drug resistance of causative pathogens from January 1, 2016, to October 1, 2021, were reviewed retrospectively. Independent risk factors for mortality were determined via univariate and multivariate analyses. Result Eighty-two CAP patients suffered from CRO infection, with mortality of 60.0%. The independent risk factors for mortality were procalcitonin > 5 ng/L (hazard ratio = 2.300, 95% confidence interval = 1.180–4.484, P = 0.014) and lactic acid > 2 mmol/L (hazard ratio = 2.101, 95% confidence interval = 1.151–3.836, P = 0.016). The pancreas was the main site of infection, followed by lung, bloodstream and urinary tract. Klebsiella pneumoniae and Acinetobacter baumannii were the main pathogenic bacteria of CRO strains with extensive antibiotic resistance (> 60%) to 6 of 8 common antibiotics, except sulfamethoxazole (56.3%) and tigecycline (33.2%). Conclusion CRO infection has become a serious threat for CAP patients, with high rates of mortality. Procalcitonin and lactic acid represent two independent risk factors for mortality in CAP patients with CRO infection. Klebsiella pneumoniae and Acinetobacter baumannii are the primary categories of CRO pathogens. Greater efforts are needed for early prevention and prompt treatment of CRO infections in CAP patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-022-00624-w.
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