Candidemia indicates poor outcome in patients with infected pancreatic necrosis

Abstract

Background Intra‐abdominal fungal infection (AFI) and candidemia are common in patients with acute pancreatitis (AP), but with limited and conflicting reports on their clinical impacts. This study aims to evaluate the clinical impacts of AFI and candidemia in infected pancreatic necrosis (IPN). Methods A single‐centre, prospective cohort including 235 consecutive patients with IPN between January 2010 and September 2020 was analysed to study the clinical impacts of AFI and candidemia. Results Of the 235 patients with IPN, 69 patients (29.4%) developed AFI and 13 patients (5.5%) developed candidemia. AFI was associated with higher intestinal leakage rate (27.5% vs 12.7%, P = .006), higher pancreatic fistula rate (53.6% vs 34.3%, P = .006) and longer hospital stays (72 vs 58 days, P = .003), but with similar mortality rate compared with patients without AFI (23.2% vs 24.7%, P = .806). However, candidemia was associated with significantly higher mortality rate compared with patients without candidemia (69.2% vs 21.6%, P < .001). Patients with candidemia had higher rate of multiple organ failure and AFI (69.2% vs 36.5%, P = .018; 69.2% vs 27.0%, P = .001, respectively). Multivariable analysis showed that age ≥ 50 years (OR = 2.8; 95% CI, 1.3‐5.8; P = .007), severe category (OR = 11.2; 95% CI, 3.5‐35.7; P < .001), multidrug‐resistant organisms infection (OR = 2.5; 95% CI, 1.0‐6.2; P = .039), candidemia (OR = 11.8; 95% CI, 2.5‐56.5; P = .002), step‐down surgical approach (OR = 3.2; 95% CI, 1.5‐7.0; P = .004) were the independent predictors associated with higher mortality in IPN patients. Conclusion Although AFI did not increase the mortality of IPN, patients with candidemia carried significantly higher mortality.

Risk Factors for Mortality Among Critical Acute Pancreatitis Patients with Carbapenem-Resistant Organism Infections and Drug Resistance of Causative Pathogens

“…The vast majority of CAP patients received antibiotics before the IPN intervention because of suspected infections with possible manifestations. In line with previous studies, our cohort demonstrated that antibiotic therapy before intervention did not significantly impact the outcomes, which may also increase the risk of drug resistance and incidence of fungal infections [ 5 , 32 ]. Given the size and limitations of these retrospective data, the comparison between monotherapy and combination prophylactic antibiotic therapy remains to be studied.…”

Impact of multiple drug-resistant Gram-negative bacterial bacteraemia on infected pancreatic necrosis patients

“…An infectious complication of AP cannot be arbitrarily defined as IPN, and it also needs to include bacteraemia or pulmonary infection ( Wu et al., 2022a ). Moreover, whilst it is often overlooked, bacteraemia, especially MDR-GNB bacteraemia, may pose a serious threat to IPN patients ( Ning et al., 2021a ). MDR-GNB bacteraemia mortalities have been reported in several studies of hospital- onset infections, but they still have not been fully addressed in IPN patients ( Tsai et al., 2014 ).…”