Risk Factors And Molecular Epidemiology For Carbapenem-Resistant Enterobacteriaceae Infections In Patients With Acute Pancreatitis

Object:To analyze the risk factors and molecular epidemiology of acute pancreatitis combined with carbapenem-resistant enterobacteriaceae（CRE）.Method:Selecting 240 patients with AP admitted to our hospital from2011 to 2019 as the research object,we divided the patients into experimental group of 60 cases and control group of 180 cases on the basis that whether these patients were co-infected with CRE or not.Furthermore,both single factor and multivariate logistic regression methods were used to analyze the risk factors of AP co-infection with CRE by combining the clinical characteristics of the patients.PCR and AGE were performed for the CRE strains of experimental group to detect the carbapenemase genes,including the bla _KPC、bla _NDM、bla _VIM、bla _IMPand bla _OXA-48.Results:The pathogenic bacteria in the experimental group are composed of Klebsiella pneumoniae of 35.00%,Escherichia coli of 33.33%,Enterobacter cloacae of 25.00%and Citrobacter freundii of 6.67%.The results of single factor analysis showed that AP co-infection with CRE was related to the patients’factors including the age,total hospitalized days,days of hospitalization before the determination of CRE,days of admission to the ICU,days of fasting,APACHE II score at admission,history of abdominal surgery,basic high lipemia,diabetes,kidney,infections of abdominal cavity or lung or urinary tract,days of ERCP,enteral nutrition,puncture,drainage tube,gastric tube,urinary catheter,venous catheter,hemofiltration,sexual manipulation and the use of antibacterial drugs before testing（P<0.05）.The results of multivariate analysis pointed out that APACHE II score,history of abdominal surgery and ERCP at admission were independent risk factors for AP co-infection with CRE（P<0.05）.The PCR results showed that among the CRE strains,carbapenemase genes were detected in 26 strains,of which bla _KPCand bla _NDMgenes were found in 17 and 15 isolates respectively,6 KPN strains were positive for a combination of bla _KPCand bla _NDM,the bla _IMP、bla _VIMand bla _OXA-48genes have not been found yet.Conclusion:AP co-infection with CRE is affected by multiple risk factors.During the clinical treatment,the active preventive treatment measures ought to be taken and the invasive procedures of ERCP should be strictly followed to decrease the incidence of infection for critically ill patients with a high APACHE II score and patients with a history of abdominal surgery.