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. 2025 Jul 1;25(1):882.
doi: 10.1186/s12879-025-11263-0.

Klebsiella predominance in peripancreatic microbial spectrum is associated with the severity of infected pancreatic necrosis

Xiaolan Guo  1 , Yao Xu  2 , Kaiwei Li  2 , Jingzhu Zhang  2 , Zhihui Tong  2 , Weiqin Li  2 , Donghuang Hong  3   4
Affiliations

Klebsiella predominance in peripancreatic microbial spectrum is associated with the severity of infected pancreatic necrosis

Xiaolan Guo et al. BMC Infect Dis. .

Abstract

Background: Infectious pancreatic necrosis (IPN) is associated with the prognosis of acute pancreatitis (AP). The correlation between microbial diversity in the peripancreatic region and AP severity remains unclear. This study investigates whether pathogen profiles in peripancreatic necrosis differ between IPN patients with and without organ failure (OF), using 16 S ribosomal RNA (16 S rRNA) and internal transcribed spacer (ITS) sequencing.

Methods: Patients with acute pancreatitis meeting clinical diagnostic criteria for IPN were prospectively enrolled. These patients were subsequently divided into an OF group and a non-OF group. Peripancreatic necrotic fluid samples were collected via percutaneous drainage and subjected to 16 S rRNA and ITS sequencing.

Results: A total of 28 patients with suspected infected pancreatic necrosis (IPN) were included, with 14 patients in the OF group and 14 in the non-OF group. No significant difference was observed in bacterial alpha diversity between the OF and non-OF groups. However, beta diversity showed significant differences according to Welch's t test (P < 0.001), Adonis analysis (P = 0.037) and Anosim analysis (P = 0.032). The relative abundance of Klebsiella significantly differed between the two groups (2.79% vs. 34.14%, P = 0.0093) and correlated with the length of hospital stay (r = 0.422, P = 0.025).

Conclusion: The peripancreatic microbial profile is associated with the severity of acute pancreatitis, with Klebsiella being the dominant microflora in patients with IPN combined with OF.

Keywords: 16S ribosomal RNA; Acute pancreatitis; Infected pancreatic necrosis; Internal transcribed spacer (ITS).

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol was approved by the Ethics Committee of Jinling Hospital (Nanjing, China; 2021NZKY-014-01). Written informed consent was obtained from all participants. The procedures followed in this study were in accordance with the principles of the Declaration of Helsinki (1964, amended most recently in 2013) of the World Medical Association. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of microbial composition and distribution between the non-OF and OF groups. a Venn diagram of shared OTUs; b cylindrical accumulation map at the phylum level; c cylindrical accumulation map at the family level; d cylindrical accumulation map at the genus level. OF: organ failure
Fig. 2
Fig. 2
Comparison of the alpha diversity indices between the non-OF and OF groups. a Chao1 index; b Shannon index; c Simpson index; d ACE index. OF: organ failure
Fig. 3
Fig. 3
Comparison of beta diversity indices between the non-OF and OF groups. a Welch’s t test; b Adonis analysis; c Anosim analysis. OF: organ failure
Fig. 4
Fig. 4
Distribution and difference in bacterial taxa composition between the non-OF and OF groups. a Welch’s t test (level phylum); b Welch’s t test (level family); c Welch’s t test (genus level). OF: organ failure
Fig. 5
Fig. 5
Spearman correlation analysis. a Correlation between the relative abundance of Klebsiella and the APACHE II score; b correlation between the relative abundance of Klebsiella and the length of hospital stay; c correlation between the relative abundance of Proteobacteria and white blood cell count
Fig. 6
Fig. 6
A cylindrical accumulation map at the genus level generated by internal transcribed spacer (ITS) sequencing. NOF represents the non-OF group, OF represents the OF group, and the numbers represent patient numbers. OF: organ failure
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