Background  The high incidence of multi-drug resistant bacterial infections in intensive care units poses a serious challenge to antimicrobial therapy in patients with acute pancreatitis receiving intensive care.

  Objective  To compare the pathogens distribution and antimicrobial resistance of patients with acute pancreatitis (AP) in the Intensive Care Unit of the Center for the Treatment of Intensive Pancreatitis of Chinese PLA General Hospital (hereinafter referred to as "our hospital") and the Medical Information Mart for Intensive Care-Ⅳ (MIMIC-Ⅳ) in the United States, and provide evidences for empirical treatment of anti-infection.

  Methods  Culture results and antimicrobial sensitivity results of specimens collected from AP admitted to our hospital from 2018 to 2019 and related data in MIMIC-Ⅳ from 2014 to 2019 were retrospectively collected and compared.

  Results  The number of AP patients in our hospital was 314, and 570 microbial strains were identified in culture; whereas the number of AP patients in MIMIC-Ⅳ was 604, and 368 microbial strains were identified in culture. Microorganisms in different specimen sources (except urine) in our hospital were predominantly Klebsiella pneumoniae (17.24%-26.92%) and Acinetobacter baumannii (13.56%-46.15%), while the most detected microorganisms in ascites, urine and venous blood in MIMIC-Ⅳ were Pseudomonas aeruginosa (17.39%), Escherichia coli (22.22%) and Klebsiella pneumoniae (16.90%), respectively, and Staphylococcus aureus was mostly abundant in respiratory specimens and central venous catheters (28.37% and 100%, respectively), and coagulase-negative Staphylococcus (21.43%) and Staphylococcus aureus (14.29%) were more common seen in bile. The percentage of multidrug-resistant organisms (MDRO) among Klebsiella pneumoniae and Acinetobacter baumannii in our hospital was over 90% (94.55% and 99.02%, respectively), and the percentage of that among Pseudomonas aeruginosa and Escherichia coli was over 80% (82.14% and 83.87%, respectively), while in MIMIC-Ⅳ, the percentage of MDRO among Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli were 25.93%, 27.59% and 26.83%, respectively.

  Conclusion  The main Gram-negative bacteria isolated from patients with AP in domestic and foreign critical care databases are mainly Gram-negative bacteria. The most common is Staphylococcus aureus in MIMIC-Ⅳ and Klebsiella pneumoniae in our hospital. And the drug resistance of the main negative bacteria is more serious than in foreign countries.