摘要
背景与目的:急性胰腺炎(AP)是常见的急腹症,部分患者可进展为中度重症急性胰腺炎(MSAP)或重症急性胰腺炎(SAP),继发感染是决定预后的关键因素。耐碳青霉烯鲍曼不动杆菌(CRAB)已成为AP继发感染的重要病原菌,其耐药性强、病死率高。本研究旨在系统分析MSAP/SAP合并CRAB感染患者的临床特征、死亡危险因素及耐药谱,并建立预测模型。方法:回顾性收集2012年1月—2022年8月中南大学湘雅医院收治的108例MSAP/SAP合并CRAB感染患者的临床资料、实验室指标及药敏结果。采用Cox回归分析筛选独立死亡危险因素,基于结果构建列线图预测模型并进行验证。结果:患者平均年龄48岁,男性占71.3%;主要病因为高脂血症(61.1%)和胆源性(33.3%)。CRAB感染部位以胰腺/胰周(44.4%)和肺部(43.5%)最常见,42.6%(46/108)患者死亡。死亡组较存活组患者年龄更大,胆源性病因比例更高,重症监护病房(ICU)入住率、机械通气、出血及感染性休克发生率明显增加(均P<0.05)。多因素Cox回归提示,年龄>60岁(HR=6.694)、出血(HR=4.466)、感染性休克(HR=4.495)、血红蛋白<80 g/L(HR=2.343)为独立死亡危险因素。药敏分析显示,175株CRAB对大多数抗生素(喹诺酮类、头孢菌素类、氨基糖苷类等)耐药率>60%,仅对替加环素相对敏感(耐药率<40%)。基于危险因素建立的列线图模型具有良好区分度(C指数=0.897)和校准度,ROC分析显示,90 d生存预测的AUC=0.897。结论:CRAB感染显著加重MSAP/SAP患者病情并使病死率升高,高龄、出血、感染性休克及严重贫血是关键死亡危险因素。列线图模型可帮助早期识别高危人群,提示临床需重视个体化防治策略,合理应用抗菌药物,加强感染控制与并发症预防,以改善患者预后。
Background and Aims:Acute pancreatitis(AP)is a common acute abdominal disease,with some patients progressing to moderately severe(MSAP)or severe acute pancreatitis(SAP).Secondary infection is a major determinant of prognosis.Carbapenem-resistant Acinetobacter baumannii(CRAB)has emerged as an important pathogen in AP,characterized by high drug resistance and mortality.This study aimed to comprehensively analyze the clinical characteristics,mortality risk factors,and antimicrobial resistance patterns of CRAB infection in MSAP/SAP patients,and to develop a predictive model.Methods:A retrospective cohort of 108 MSAP/SAP patients with CRAB infection admitted to Xiangya Hospital,Central South University,between January 2012 and August 2022 was analyzed.Clinical data,laboratory parameters,and antimicrobial susceptibility results were collected.Cox regression was performed to identify independent mortality risk factors,and a nomogram prediction model was constructed and validated.Results:The cohort comprised 108 patients(mean age 48 years,71.3%male).The leading etiologies were hypertriglyceridemia(61.1%)and biliary causes(33.3%).The most common infection sites were the pancreas/peripancreatic region(44.4%)and the lungs(43.5%).Overall mortality was 42.6%(46/108).Compared with survivors,deceased patients were older,more frequently had biliary etiology,ICU admission,mechanical ventilation,hemorrhage,and septic shock(all P<0.05).Multivariate Cox regression identified age>60 years(HR=6.694),hemorrhage(HR=4.466),septic shock(HR=4.495),and hemoglobin<80 g/L(HR=2.343)as independent predictors of death.Among 175 CRAB isolates,resistance rates exceeded 60%for most antibiotics,while tigecycline showed the lowest resistance(<40%).The nomogram model demonstrated excellent discrimination(C-index=0.897)and calibration,with an AUC of 0.897 for 90-day survival prediction.Conclusion:CRAB infection significantly worsens clinical outcomes in MSAP/SAP patients,with advanced age,hemorrhage,septic shock,and severe anemia as key mortality risk factors.The nomogram provides an effective tool for early identification of high-risk patients.Tailored therapeutic strategies,rational antibiotic use,and prevention of complications are essential to improving prognosis in this population.
作者
莫吉祥
彭燕
彭杰
MO Jixiang;PENG Yan;PENG Jie(Xiangtan Vocational&Technical College,Xiangtan,Hunan 411104,China;Department of Gastroenterology,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《中国普通外科杂志》
北大核心
2025年第7期1473-1480,共8页
China Journal of General Surgery
基金
湖南省职业教育教学改革研究基金资助项目(ZJGB2022073)。
关键词
胰腺炎
鲍氏不动杆菌
抗药性
细菌
死亡
危险因素
列线图
Pancreatitis
Acinetobacter baumannii
Drug Resistance,Bacterial
Death
Risk Factors
Nomograms
