The role of extra-pancreatic infections in the prediction of severity and local complications in acute pancreatitis

Pando, Elizabeth; Alberti, Piero; Vidal, Laura; Trape, M. Adell; Gómez, Concepción; Caralt, M.; Blanco, L.; Dopazo, C.; Balsells, J.; Charco, R.

doi:10.1016/j.hpb.2018.06.1913

Cited by 7 publications

(13 citation statements)

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“…According to the analysis of extrapancreatic infection time in NP patients, the extrapancreatic infection time was earlier than the pancreatic infection time, consistent with the conclusions of other studies[4,5,7,8]. In both early (< 14 d) and late (> 42 d) infections, bacteremia is a common source of infection.…”

Section: Discussionsupporting

confidence: 89%

“…In both early (< 14 d) and late (> 42 d) infections, bacteremia is a common source of infection. In the early stage, bacteremia may occur due to the suppression of immune function by a systemic inflammatory reaction, which may affect the prognosis of NP patients[5]. Brown et al[4] noted that the most common manifestations of extrapancreatic infections in severe AP patients were respiratory tract infections (9.2%) and bacteremia (8.4%).…”

Section: Discussionmentioning

confidence: 99%

“…Common sites of extrapancreatic infection include the blood, respiratory tract, urinary tract, abdominal cavity, biliary tract, and surgical incision site[7-9]. When infection symptoms are suspected in AP patients, but no definite signs of infection (bubbles) are found in the necrotic pancreatic tissue on imaging, and the culture of necrotic tissue and pus from puncture and drainage is negative, suspected patients with extrapancreatic infection can be diagnosed or excluded by multiple, multisite pathogen culture[4,5,7-9].…”

Section: Materialsandmethodsmentioning

confidence: 99%

“…Approximately 40% to 70% of NP patients have infectious complications, which usually indicate a worse prognosis. Infection is an important sign of complications in NP patients[1-5]. To date, studies on pancreatic infection have mainly focused on pancreatic and peripancreatic infection, but few have focused on extrapancreatic infection and coinfection.…”

Section: Introductionmentioning

confidence: 99%

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Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis

Lu¹,

Cao²,

Ding³

et al. 2019

WJG

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BACKGROUNDAcute pancreatitis (AP) is a common acute abdominal disease worldwide, and its incidence rate has increased annually. Approximately 20% of AP patients develop into necrotizing pancreatitis (NP), and 40% to 70% of NP patients have infectious complications, which usually indicate a worse prognosis. Infection is an important sign of complications in NP patients.AIMTo investigate the difference in infection time, infection site, and infectious strain in NP patients with infectious complications.METHODSThe clinical data of AP patients visiting the Department of General Surgery of Xuanwu Hospital of Capital Medical University from January 1, 2014 to December 31, 2018 were collected retrospectively. Enhanced computerized tomography or magnetic resonance imaging findings in patients with NP were included in the study. Statistical analysis of infectious bacteria, infection site, and infection time in NP patients with infectious complications was performed, because knowledge about pathogens and their antibiotic susceptibility patterns is essential for selecting an appropriate antibiotic. In addition, the factors that might influence the prognosis of patients were analyzed.RESULTSIn this study, 539 strains of pathogenic bacteria were isolated from 162 patients with NP infection, including 212 strains from pancreatic infections and 327 strains from extrapancreatic infections. Gram-negative bacteria were the main infectious species, the most common of which were Escherichia coli and Pseudomonas aeruginosa. The extrapancreatic infection time (9.1 ± 8.8 d) was earlier than the pancreatic infection time (13.9 ± 12.3 d). Among NP patients with early extrapancreatic infection (< 14 d), bacteremia (25.12%) and respiratory tract infection (21.26%) were predominant. Among NP patients with late extrapancreatic infection (> 14 d), bacteremia (15.94%), respiratory tract infection (7.74%), and urinary tract infection (7.71%) were predominant. Drug sensitivity analysis showed that P. aeruginosa was sensitive to enzymatic penicillins, third- and fourth-generation cephalosporins, and carbapenems. Acinetobacter baumannii and Klebsiella pneumoniae were sensitive only to tigecycline; Staphylococcus epidermidis and Enterococcus faecium were highly sensitive to linezolid, tigecycline, and vancomycin.CONCLUSIONIn this study, we identified the timing, the common species, and site of infection in patients with NP.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Materialsandmethodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis

Lu¹,

Cao²,

Ding³

et al. 2019

WJG

View full text Add to dashboard Cite

show abstract

“…In a prospective Spanish study of 176 patients with AP, 25% developed extrapancreatic infections including pneumonia, urinary tract infections, catheter line infections, and bacteremia. The presence of pneumonia and/or bacteremia was associated with increased mortality [ 13 ]. In an American study of 11,046 patients with AP, 15% of the causes of death were attributed to a nosocomial infection [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Increased Mortality from Extrapancreatic Infections in Hospitalized Patients with Acute Pancreatitis

Grajales-Figueroa

Hernández

Portillo

et al. 2019

Gastroenterology Research and Practice

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Nosocomial extrapancreatic infections in patients with acute pancreatitis (AP) are associated with a higher mortality even after adjusting the risk for the severity of the pancreatitis. The aim of this study was to describe the clinical features of hospitalized patients with AP who died during their hospitalization and to evaluate risk factors associated with mortality. We performed a descriptive study of the clinical features of adult patients who died from AP during their hospitalization and a case control study with a paired group of patients that survived AP during a 10-year period. Data of interest were collected from the medical records and are presented with appropriate measures of central tendency and dispersion. For the case control study, the primary outcome evaluated was death, and to evaluate associated clinical features and determine differences between groups, we performed the χ2 or Fisher’s exact tests for categorical variables and the Student t-test or Mann-Whitney U test for continuous variables as appropriate. We found 48 patients with acute pancreatitis who died within the period of the study during hospitalization; from these, 50% were men, mean age was 53.2 years, and the most common etiology was biliary obstruction by gallstones in 45.8%. The global mortality rate was of 2.5%. A total of 43.7% patients had infected pancreatic necrosis, and in 58.3%, some extrapancreatic infection was documented, being the most common urinary tract infection in 50%, bacteremia in 50% and pneumonia in 33.3%. Clinical features associated with mortality were the presence of organ failure (p<0.001), nosocomial complications (p<0.001), infected necrosis (p<0.001), and extrapancreatic infections (p=0.002). From the different extrapancreatic infections, only bacteremia (p=0.001) and pneumonia (p=0.011) were associated with higher mortality. In conclusion, extrapancreatic infections are associated with increased mortality among hospitalized patients with acute pancreatitis, in particular, bacteremia and pneumonia with an isolated pathogen.

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Extrapancreatic Complications in Hospitalized Patients With Mild Acute Pancreatitis Are Associated With Poorer Outcomes

Shah¹,

Yakah²,

Ahmed³

et al. 2022

Pancreas

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ObjectivePatients with acute pancreatitis (AP) are at risk for extrapancreatic complications (EPCs) when admitted to the intensive care unit (ICU). We assessed the prevalence of EPCs in non-ICU AP patients and their outcomes.MethodsWe retrospectively studied EPCs in non-ICU AP patients between 2008 and 2018. Outcomes such as length of stay (LOS), inpatient mortality, and 30-day readmission rates were compared between those with and without EPC.ResultsOf the 830 AP patients, 151 (18.1%) had at least 1 EPC. These included urinary tract infection (15.9%), Clostridium difficile infection (17.2%), pneumonia (7.3%), bacteremia (17.2%), acute kidney injury requiring dialysis (3.3%), gastrointestinal bleeding (12.5%), alcohol withdrawal (24.5%), delirium (14.5%), and falls (1.32%). Patients with EPC had increased mean LOS (6.98 vs 4.42 days; P < 0.001) and 30-day readmissions (32.5% vs 19%; P < 0.001). On multivariate regression, EPCs were independently associated with higher LOS (odds ratio, 1.45 [95% confidence interval, 1.36–1.56]; P < 0.001) and 30-day readmissions (odds ratio, 1.94 [95% confidence interval 1.28–2.95]; P < 0.001).ConclusionsThe EPCs are common among noncritical AP patients and contribute to poor outcomes like increased LOS and 30-day readmissions.

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The role of extra-pancreatic infections in the prediction of severity and local complications in acute pancreatitis

Abstract: Conclusion: Rising in BUN over 24h plays a role in the prediction of severity and local complications in acute pancreatitis. Haematocrit 44% on admission plays a role in the prediction of pancreatic necrosis.

Cited by 7 publications

References 0 publications

Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis

Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis

Increased Mortality from Extrapancreatic Infections in Hospitalized Patients with Acute Pancreatitis

Extrapancreatic Complications in Hospitalized Patients With Mild Acute Pancreatitis Are Associated With Poorer Outcomes

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