Invasive candidiasis in severe acute pancreatitis: Experience from a tertiary care teaching hospital

Abstract

Background:Invasive candidiasis (IC) is associated with increased morbidity in severe acute pancreatitis (SAP). There is limited information regarding the predisposing factors, Candida species distribution and in vitro susceptibility.Methodology:Current data have been derived from a larger prospective nonintervention study conducted on 200 critically ill patients which was done to study the antifungal prescription practices, collect epidemiological data, and perform an external validation of risk prediction models for IC under senior research associateship program of Council of Scientific and Industrial Research New Delhi. Of these critically ill patients, thirty had SAP and were included for analysis.Results:There were 23 males and 7 females. Out of eight patients (27%) who developed IC, three had isolated candidemia, two had isolated deep-seated candidiasis while three had both candidemia and deep-seated candidiasis. SAP patients with IC had a longer duration of Intensive Care Unit stay, hospital stay, days on mechanical ventilation and duration of shock. Mortality was not different between SAP patients with or without IC.Conclusion:There is a high rate of Candida infection in SAP. More studies are needed to generate epidemiological data and develop antifungal stewardship in this subset of high-risk population.

Management of infected pancreatic necrosis in the intensive care unit: a narrative review

“…Importantly, this study found that previous antibiotic treatment was strongly associated with the presence of multiresistant bacteria in infected collections (78% versus 21% without previous antibiotic treatment) [36,37]. Prolonged treatment with multiple broad-spectrum antibiotics is known to cause a profound alteration in the endogenous flora, promoting the growth of Candida species [15,38]. Fungal infections prior to antibiotic treatment occur in about 5e8% of cases, but after treatment with antibiotics the incidence of fungal infection rises to 20e30% [15,38,39].…”

“…Prolonged treatment with multiple broad-spectrum antibiotics is known to cause a profound alteration in the endogenous flora, promoting the growth of Candida species [15,38]. Fungal infections prior to antibiotic treatment occur in about 5e8% of cases, but after treatment with antibiotics the incidence of fungal infection rises to 20e30% [15,38,39].…”

Candidemia indicates poor outcome in patients with infected pancreatic necrosis

“…Fungal infection of pancreatic necrosis has also been increasingly reported in the last decade. The incidence of intra‐abdominal fungal infection (AFI) varies from 3.5% to 46% 5‐7,10‐17 . A variety of factors, including antimicrobial overuse, total parenteral nutrition (TPN), longer hospital stays and frequent use of invasive interventions, predispose patients to AFI 10‐12,17,18 .…”

“…AFI carries significant morbidity and mortality in patients with acute pancreatitis (AP). However, in the last decade, dozens of studies have reported conflicting results 5‐7,10‐17 . Some studies found an increased mortality due to fungal infection, whereas others observed no significant change in the mortality.…”

Primary Pancreatic Candidiasis Mimicking Pancreatic Cancer in an Immunocompetent Patient

“…Pancreatic fungal infections occur in patients with severe acute pancreatitis, 7 a history of surgical manipulation of the abdomen after an episode of acute pancreatitis, ERCP, 8 total parenteral nutrition, and mechanical ventilation. 9 An altered host immune system due to chemotherapy, steroid therapy, comorbid diabetes mellitus, and advanced age is also a predisposing risk factor for pancreatic fungal infections.…”