Candida in Acute Pancreatitis

IntroductionPatients with severe acute pancreatitis are at risk of candidal infections carrying the potential risk of an increase in mortality. Since early diagnosis is problematic, several clinical risk scores have been developed to identify patients at risk. Such patients may benefit from prophylactic antifungal therapy while those patients who have a low risk of infection may not benefit and may be harmed. The aim of this study was to assess the validity and discrimination of existing risk scores for invasive candidal infections in patients with severe acute pancreatitis.MethodsPatients admitted with severe acute pancreatitis to the intensive care unit were analysed. Outcomes and risk factors of admissions with and without candidal infection were compared. Accuracy and discrimination of three existing risk scores for the development of invasive candidal infection (Candida score, Candida Colonisation Index Score and the Invasive Candidiasis Score) were assessed.ResultsA total of 101 patients were identified from 2003 to 2011 and 18 (17.8%) of these developed candidal infection. Thirty patients died, giving an overall hospital mortality of 29.7%. Hospital mortality was significantly higher in patients with candidal infection (55.6% compared to 24.1%, P = 0.02). Candida colonisation was associated with subsequent candidal infection on multivariate analysis. The Candida Colonisation Index Score was the most accurate test, with specificity of 0.79 (95% confidence interval [CI] 0.68 to 0.88), sensitivity of 0.67 (95% CI 0.41 to 0.87), negative predictive value of 0.91 (95% CI 0.82 to 0.97) and a positive likelihood ratio of 3.2 (95% CI 1.9 to 5.5). The Candida Colonisation Index Score showed the best discrimination with area under the receiver operating characteristic curve of 0.79 (95% CI 0.69 to 0.87).ConclusionsIn this study the Candida Colonisation Index Score was the most accurate and discriminative test at identifying which patients with severe acute pancreatitis are at risk of developing candidal infection. However its low sensitivity may limit its clinical usefulness.

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“…In this study, as in previous studies, there was no difference in the incidence of ICI in patients with either aetiology [31]. …”

Section: Discussionsupporting

confidence: 88%

Prediction of invasive candidal infection in critically ill patients with severeacute pancreatitis

et al. 2013

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“…Most commonly, candida complicates acute necrotizing pancreatitis rather than causes it. Moreover, candida is also often responsible for a longer hospital stay and increased mortality rates [50]. …”

Section: Fungal Causes Of Apmentioning

confidence: 99%

Review of Infectious Etiology of Acute Pancreatitis

2017

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While gallstones and alcoholism are widely known to be the most common causative agents of acute pancreatitis, about 10% of cases are thought to be caused by infectious microorganisms. These microorganisms include viruses (e.g. mumps, Coxsackie B, and hepatitis), bacteria (e.g. Mycoplasma pneumoniae and leptospirosis), and parasites (e.g. Ascaris lumbricoides, Fasciola hepatica, and hydatid disease). Each organism causes acute pancreatitis through diverse mechanisms. The review is primarily conducted in an attempt to provide a better understanding of the possibility of acute pancreatitis presenting as a complication relating to these organisms, and the aim is to guide future diagnoses, management, and predictions of complications.

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“…Less commonly, Candida albicans has been cultured from pancreatic infections, almost always as part of polymicrobial infections. 1 Most of the reported cases had factors like immunosuppression, malignancy, drug induced, diabetes, etc. as comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Candida and Enterobacter co-infection in a case of periampullary carcinoma with obstructive jaundice

et al. 2015

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Candida in Acute Pancreatitis

Abstract: This study thus emphasizes the important role of Candida infection in patients with acute pancreatitis and demonstrates the need for early attention.

Cited by 30 publications

References 21 publications

Prediction of invasive candidal infection in critically ill patients with severeacute pancreatitis

Prediction of invasive candidal infection in critically ill patients with severeacute pancreatitis

Review of Infectious Etiology of Acute Pancreatitis

Candida and Enterobacter co-infection in a case of periampullary carcinoma with obstructive jaundice

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