老年急性胰腺炎合并感染的病原菌分布及影响因素分析

Analysis of pathogenic bacteria distribution and its influencing factors in elderly patients with acute pancreatitis complicated with infection

中文关键词: 老年  急性胰腺炎  感染  病原菌  相关因素

英文关键词: elderly  acute pancreatitis  infection  pathogenic bacteria  related factor

中文摘要:

      目的 探讨老年急性胰腺炎合并感染患者病原菌分布及影响因素.方法 回顾性分析山西医科大学附属运城市中心医院2021年8月—2024年8月收治的149例老年急性胰腺炎患者临床资料,根据是否合并感染分为感染组和未感染组,分析感染组患者病原菌分布,比较2组患者临床特征,ROC曲线分析实验室指标预测合并感染的最佳截断值,Logistic二元回归方程分析影响老年急性胰腺炎合并感染的影响因素.结果 149例老年急性胰腺炎患者中,合并感染患者47例(31.54％),未合并感染患者102例(68.46％),共检出病原菌93株,其中来源于穿刺样本49株(52.69％),胆汁样本19株(20.43％),痰液样本13株(13.98％),血液样本11株(11.83％),尿液样本1株(1.08％),革兰氏阴性菌66株(70.97％),革兰氏阳性菌26株(27.96％),真菌1株(1.07％);与未感染组比较,感染组患者年龄≥70岁、重症胰腺炎、ICU患者、APACHEⅡ评分≥15分、机械通气、留置导管时间(腹腔引流管、胸腔引流管、深静脉导管)≥7 d占比及C反应蛋白(CRP)、降钙素原(PCT)水平均升高(P＜0.05),血清白蛋白(ALB)水平降低(P＜0.05);CRP、PCT、ALB预测老年胰腺炎合并感染的AUC在0.711～0.852范围(P＜0.05);Logistic回归分析结果显示,年龄≥70岁、重症胰腺炎、ICU患者、APACHE Ⅱ评分≥15分、机械通气、留置导管时间≥7 d、CRP≥118.09 mg/L、PCT≥6.56 ng/mL、ALB≤32.92 g/L均为老年急性胰腺炎合并感染的危险因素(P＜0.05).结论 老年急性胰腺炎合并感染的病原菌以革兰氏阴性菌为主,年龄、重症胰腺炎、高APACHEⅡ评分、机械通气、长时间留置导管、高CRP、PCT水平及低ALB水平均为老年急性胰腺炎合并感染的危险因素.

英文摘要:

      Objective To investigate the pathogenic bacteria distribution and influencing factors in elderly patients with acute pancreatitis complicated with infection.Methods A retrospective analysis was conducted on the clinical data of 149 eld-erly patients with acute pancreatitis admitted to Yuncheng Central Hospital Affiliated to Shanxi Medical University from August 2021 to August 2024.They were divided into infection group and non-infection group according to whether they were compli-cated with infection.The distribution conditions of pathogenic bacteria in the infection group were analyzed,and the clinical characteristics were compared between the two groups.ROC curve was used to analyze the optimal cut-off value of laboratory indicators for predicting co-infection,and the Logistic binary regression equation was used to analyze the influencing factors for co-infection in elderly patients with acute pancreatitis.Results Among 149 elderly patients with acute pancreatitis,47 cases(31.54％)were complicated with infection,and 102 ones(68.46％)were not.A total of 93 strains of pathogenic bacteria were detected,including 49 strains(52.69％)from puncture samples,19 strains(20.43％)from bile samples,13 strains(13.98％)from sputum samples,11 strains(11.83％)from blood samples and 1 strain(1.08％)from urine sample.There were 66 strains of Gram-negative bacteria(70.97％),26 strains of Gram-positive bacteria(27.96％)and 1 strains of fungi(1.07％).Compared with the non-infected group,the proportions of patients aged ≥ 70 years,with severe pancreatitis,ICU patients,APACHE Ⅱ score ≥ 15 points,mechanical ventilation and indwelling catheter time(abdominal drainage tube,thoracic drainage tube,deep venous catheter)≥7 d,and the levels of C-reactive protein(CRP)and procalcitonin(PCT)in the infec-tion group increased(P＜0.05),while the level of serum albumin(ALB)decreased(P＜0.05).The AUC of CRP,PCT and ALB in predicting infection in elderly patients with pancreatitis ranged from 0.711-0.852(P＜0.05).Logistic regression analysis showed that age≥70 years old,severe pancreatitis,ICU patients,APACHE Ⅱ score≥15 points,mechanical ventila-tion,venous catheterization time≥7 d,CRP≥118.09 mg/L,PCT≥ 6.56 ng/mL and ALB ≤32.92 g/L were risk factors for the infection in elderly patients with acute pancreatitis(P＜0.05).Conclusion The pathogenic bacteria in elderly patients with acute pancreatitis complicated with infection are mainly Gram-negative bacteria.Age,severe pancreatitis,high APACHEⅡ score,mechanical ventilation,long-term indwelling catheter,high levels of CRP and PCT and low level of ALB are all risk factors for infection in elderly patients with acute pancreatitis.