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Sun N, Chen Y, Zhang J, Cao J, Huang H, Wang J, Guo W, Li X. Identification and characterization of pancreatic infections in severe and critical acute pancreatitis patients using 16S rRNA gene next generation sequencing. Front Microbiol 2023; 14:1185216. [PMID: 37389346 PMCID: PMC10303115 DOI: 10.3389/fmicb.2023.1185216] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Objectives This study aimed to identify the bacterial composition in the pancreatic fluid of severe and critical acute pancreatitis (SAP and CAP) patients. Methods A total of 78 pancreatic fluid samples were collected from 56 SAP and CAP patients and analyze using aerobic culture and 16S rRNA gene next-generation sequencing. The clinical data of the patients were obtained from the electronic medical records. Results Among the total 78 samples, 16S rRNA gene NGS identified a total of 660 bacterial taxa, belonging to 216 species in 123 genera. The dominant aerobic bacteria included Klebsiella pneumoniae, Acinetobacter baumannii, and Enterococcus faecium, while the dominant anaerobic bacteria included Bacteroides, Dialister invisus, and Olsenella uli. As compared to aerobic culturing, 95.96% (95/99) of the aerobic cultured bacteria were detected using the 16S rRNA gene NGS. Conclusion The pancreatic infections in SAP and CAP patients might originate not only from the gut but also from the oral cavity and airways as well as related environments. Dynamic analysis of bacterial profile and abundance showed that some bacteria with low abundance might become the main pathogenic bacteria. There were no significant differences in the bacterial diversity between SAP and CAP.
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Affiliation(s)
- Ning Sun
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yong Chen
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jiaxun Zhang
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jin Cao
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Hongjuan Huang
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jie Wang
- Clinical Medicine Research Center, The Affiliated Suqian First People’s Hospital of Nanjing Medical University, Suqian, China
| | - Wentao Guo
- Department of Microbiology and Immunology, College of Basic Medicine, Guangdong Medical University, Dongguan, China
| | - Xiaojun Li
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Hong D, Wang P, Chen Y, Zhang J, Jiang W, Ye B, Li G, Zhou J, Mao W, Tong Z, Li W, Ke L. Detection of potential pathogen in pancreatic fluid aspiration with metagenomic next-generation sequencing in patients with suspected infected pancreatic necrosis. Dig Liver Dis 2023; 55:243-248. [PMID: 35948458 DOI: 10.1016/j.dld.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Timely and accurate microbial diagnosis is important in managing patients with infected pancreatic necrosis (IPN). AIMS To evaluate the diagnostic performance of Metagenomic next-generation sequencing (mNGS) in patients with suspected IPN. METHODS The clinical data of 40 patients with suspected IPN who underwent CT-guided pancreatic fluid aspiration were retrospectively analyzed. Microbial culture and mNGS were simultaneously applied to identify the potential pathogens. The diagnostic performance of the mNGS was assessed by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS The mNGS report can be obtained significantly earlier than culture methods (42 (36-62 h) vs. 60 (42-124 h), P = 0.032). Across all the study samples, seven species of bacteria and two species of fungi were reported accordingly to the culture results, while 22 species of bacteria and two species of fungi were detected by mNGS. The sensitivity, specificity, NPV, and PPV of mNGS were 88.0%, 100%, 83.33%, and 100%, respectively. CONCLUSIONS The diagnostic accuracy of mNGS in patients with suspected IPN is satisfactory. Moreover, mNGS may broaden the range of identifiable infectious pathogens and provide a more timely diagnosis.
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Affiliation(s)
- Donghuang Hong
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Peng Wang
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yingjie Chen
- Department of Critical Care Medicine, Jinjiang Hospital of Traditional Chinese Medicine, Jinjiang, China
| | - Jingzhu Zhang
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wendi Jiang
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bo Ye
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Gang Li
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jing Zhou
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenjian Mao
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhihui Tong
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weiqin Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China; Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China; National Institute of Healthcare Data Science, Nanjing University, Nanjing, China.
| | - Lu Ke
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China; National Institute of Healthcare Data Science, Nanjing University, Nanjing, 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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Wu D, Huang Y, Ding J, Jia Y, Liu H, Xiao J, Peng J. Impact of carbapenem-resistant Acinetobacter baumannii infections on acute pancreatitis patients. Pancreatology 2022; 22:194-199. [PMID: 34924296 DOI: 10.1016/j.pan.2021.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/01/2021] [Accepted: 12/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAB) infections present great challenges in clinical practices with high mortality. The aim of this study is to identify the impact of CRAB infections on acute pancreatitis (AP). METHODS A case-control study was performed via collecting data from March 1st, 2016 to August 1st, 2020 in two comprehensive teaching hospital. Clinical data of the CRAB-positive AP patients were analyzed and compared to a matched control group (case-control ratio of 1:1). Comparisons were preformed between with/without CRAB infections and multiple organ failure (MOF), respectively. Independent risk factors of overall mortality were determined via univariate and multivariate analyses. RESULTS CRAB infections were associated with higher mortality (49.2% vs. 23.0%, P < 0.01). CRAB combined with MOF increased a mortality up to 90% (P < 0.01). MOF (Odds ratio (OR) = 21.49, 95% confidence interval (CI) = 5.26-87.80, P < 0.01), CRAB infections (OR = 3.58, 95%CI = 1.24-10.37, P = 0.02) and hemorrhage (OR = 3.70, 95%CI = 1.21-11.28, P = 0.02) were independent risk factors of overall mortality. Lung was the most common site of strains (37 of 82). CRAB strains were highly resistant (>60%) to ten of eleven common antibiotics, except for tigecycline (28%). CONCLUSION High mortality rate in AP patients was associated with CRAB infections and further increased when CRAB infections combined with MOF.
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Affiliation(s)
- Di Wu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China.
| | - Yilin Huang
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China.
| | - Junjie Ding
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China.
| | - Yan Jia
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China.
| | - Huanmiao Liu
- Emergency Department, Third Xiangya Hospital, Central South University, Changsha, China.
| | - Jie Xiao
- Emergency Department, Third Xiangya Hospital, Central South University, Changsha, China.
| | - Jie Peng
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China.
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Chen S, Shi J, Chen M, Ma J, Zeng Z, Wang R, Cui Y, Gao X. Characteristics of and risk factors for biliary pathogen infection in patients with acute pancreatitis. BMC Microbiol 2021; 21:269. [PMID: 34610799 PMCID: PMC8493750 DOI: 10.1186/s12866-021-02332-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/28/2021] [Indexed: 02/02/2023] Open
Abstract
Background Infection in patients with acute pancreatitis, especially severe acute pancreatitis patients, is a common and important phenomenon, and the distributions and drug resistance profiles of bacteria causing biliary infection and related risk factors are dynamic. We conducted this study to explore the characteristics of and risk factors for bacterial infection in the biliary tract to understand antimicrobial susceptibility, promote the rational use of antibiotics, control multidrug-resistant bacterial infections and provide guidance for the treatment of acute pancreatitis caused by drug-resistant bacteria. Methods The distribution of 132 strains of biliary pathogenic bacteria in patients with acute pancreatitis from January 2016 to December 2020 were analyzed. We assessed drug resistance in the dominant Gram-negative bacteria and studied the drug resistance profiles of multidrug-resistant bacteria by classifying Enterobacteriaceae and nonfermentative bacteria. We then retrospectively analyzed the clinical data and risk factors associated with 72 strains of Gram-negative bacilli, which were divided into multidrug-resistant bacteria (50 cases) and non-multidrug-resistant bacteria (22 cases). Results The main bacteria were Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli had a 66.67% detection rate. Acinetobacter baumannii had more than 50.00% drug resistance to carbapenems, ESBL-producing Klebsiella pneumoniae had 100.00% drug resistance, and Pseudomonas aeruginosa had 66.67% resistance to carbapenems. Multivariate logistic regression analysis suggested that the administration of third- or fourth-generation cephalosporins was an independent risk factor for Gram-negative multidrug-resistant biliary bacterial infection in acute pancreatitis patients. Conclusion Drug resistance among biliary pathogens in acute pancreatitis patients remains high; therefore, rational antimicrobial drug use and control measures should be carried out considering associated risk factors to improve diagnosis and treatment quality in acute pancreatitis patients.
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Affiliation(s)
- Shayan Chen
- Department of Laboratory Science, Tianjin Medical University NanKai Hospital, Tianjin, 300100, China.,Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Tianjin Medical University NanKai Hospital, Tianjin, 300100, China
| | - Jiyu Shi
- Tianjin Medical University, Tianjin, 300070, China
| | - Minghui Chen
- Department of Laboratory Science, Tianjin Medical University NanKai Hospital, Tianjin, 300100, China
| | - Jun Ma
- Department of Laboratory Science, Tianjin Medical University NanKai Hospital, Tianjin, 300100, China
| | - Zhaowei Zeng
- Department of Laboratory Science, Tianjin Medical University NanKai Hospital, Tianjin, 300100, China
| | - Rui Wang
- Department of Laboratory Science, Tianjin Medical University NanKai Hospital, Tianjin, 300100, China
| | - Yunfeng Cui
- Department of Surgery, Tianjin Medical University NanKai Hospital, 122 Sanwei Road, Nankai District, Tianjin, 300100, China.
| | - Xue Gao
- Binzhou Medical University, Yantai City, 264003, Shandong, China.
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Predictors of Mortality and Drug Resistance Among Carbapenem-Resistant Enterobacteriaceae-Infected Pancreatic Necrosis Patients. Infect Dis Ther 2021; 10:1665-1676. [PMID: 34215975 PMCID: PMC8322183 DOI: 10.1007/s40121-021-00489-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction 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. Methods 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. Results 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). Conclusion 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. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00489-5.
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Li W, Cao Q. Efficacy of Graded Emergency Nursing on Acute Pancreatitis Patients: A Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:1097-1107. [PMID: 34540731 PMCID: PMC8410971 DOI: 10.18502/ijph.v50i6.6409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The efficacy of graded emergency nursing on acute pancreatitis (AP) patients was evaluated by the Meta-analysis system. METHODS The databases of CNKI, WanFang, VIP, PubMed, the Cochrane Library and Web of Science were searched by computer in January 2021. The references were screened according to the inclusion and exclusion criteria. The data were extracted and the quality of those references was evaluated. Meta-analysis was made by RevMan 5.4 software, publication bias was detected by funnel chart, and sensitivity analysis was carried out. RESULTS Thirteen papers were included, including 11 waiting time indexes, 7 disease judgment accuracy indexes, 13 rescue success rate indexes and 5 patient satisfaction rate indexes. Meta-analysis showed that compared with conventional emergency nursing methods, graded emergency nursing methods had shorter waiting time (MD=-11.97, 95%CI (-15.74, -8.21), P<0.00001), higher accuracy in judging illness (OR=6.6, 95%CI (3.13, 13,93), P<0.00001) and rescue success rate (OR=7.12, 95%CI (4.16, 12.20), P<0.00001), and patients' satisfaction was higher (OR=8.79, 95%CI (3.59, 21.56), P<0.00001). CONCLUSION Graded emergency nursing can optimize the allocation of emergency resources, effectively shorten the waiting time of AP patients. It also improves the accuracy of disease judgment, the success rate of rescue and the satisfaction of patients. It is an efficient emergency nursing method and is worthy of clinical application.
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Affiliation(s)
- Wenna Li
- Medical Insurance Office, Jinan Central Hospital, Jinan 250013, China
| | - Qiuhong Cao
- Department of Anesthesiology, Jinan Central Hospital, Jinan 250013, China
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