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

Pando, Elizabeth; Alberti, Piero; Hidalgo, Nils Jimmy; Vidal, Laura; Dopazo, Cristina; Caralt, M.; Blanco, L.; Gómez‐Gavara, Concepción; Bilbao, Itxarone; Balsells, J.; Charco, Ramón

doi:10.1016/j.pan.2018.05.481

Cited by 28 publications

(19 citation statements)

References 23 publications

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“…The mortality rate in our cohort was similar to that previously reported [6, 8, 9, 23]. Patients who received delayed AIT had poorer outcomes in terms of morbidity, nosocomial infections and length of ICU stay, despite a less severe clinical status on admission.…”

Section: Discussionsupporting

confidence: 87%

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Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study

et al. 2019

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BackgroundRecent international guidelines for acute pancreatitis (AP) recommend limiting anti-infective therapy (AIT) to cases of suspected necrotizing AP or nosocomial extrapancreatic infection. Limited data are available concerning empirical and documented AIT prescribing practices in patients admitted to the intensive care unit (ICU) for the management of AP.MethodsUsing a multicentre, retrospective (2009–2014), observational database of ICU patients admitted for AP, our primary objective was to assess the incidence of AIT prescribing practices during the first 30 days following admission. Secondary objectives were to assess the independent impact of centre characteristics on the incidence of AIT and to identify factors associated with crude hospital mortality in a logistic regression model.ResultsIn this cohort of 860 patients, 359 (42%) received AIT on admission. Before day 30, 340/359 (95%) AIT patients and 226/501 (45%) AIT-free patients on admission received additional AIT, mainly for intra-abdominal and lung infections. A large heterogeneity was observed between centres in terms of the incidence of infections, therapeutic management including AIT and prognosis. Administration of AIT on admission or until day 30 was not associated with an increased mortality rate. Patients receiving AIT on admission had increased rates of complications (septic shock, intra-abdominal and pulmonary infections), therapeutic (surgical, percutaneous, endoscopic) interventions and increased length of ICU stay compared to AIT-free patients. Patients receiving delayed AIT after admission and until day 30 had increased rates of complications (respiratory distress syndrome, intra-abdominal and pulmonary infections), therapeutic interventions and increased length of ICU stay compared to those receiving AIT on admission. Risk factors for hospital mortality assessed on admission were age (adjusted odds ratio [95% confidence interval] 1.03 [1.02–1.05]; p < 0.0001), Balthazar score E (2.26 [1.43–3.56]; p < 0.0001), oliguria/anuria (2.18 [1.82–4.33]; p < 0.0001), vasoactive support (2.83 [1.73–4.62]; p < 0.0001) and mechanical ventilation (1.90 [1.15–3.14]; p = 0.011), but not AIT (0.63 [0.40–1.01]; p = 0.057).ConclusionsHigh proportions of ICU patients admitted for AP receive AIT, both on admission and during their ICU stay. A large heterogeneity was observed between centres in terms of incidence of infections, AIT prescribing practices, therapeutic management and outcome. AIT reflects the initial severity and complications of AP, but is not a risk factor for death.

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Section: Discussionsupporting

confidence: 87%

“…Most publications focusing on AIT in patients with AP have reported single-centre experiences [3–8], while multicentre data on the clinical and microbiological features of acute infections in ICU patients are rare. The largest multicentre point-prevalence study collected data from ICU patients one decade ago during the EPIC II trial [9].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study

et al. 2019

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“…Additional studies [32] have shown that EPI occurs before pancreatic infection. Elizabeth et al [33] found that pulmonary infection in INP patients usually occurred earlier than INP, and the patients had the same pathogen in the bronchial site and pancreatic necrosis. Multivariate analysis showed that lung infection was associated with mortality and INP.…”

Section: Discussionmentioning

confidence: 99%

The impacts of infectious complications on outcomes in acute pancreatitis: a retrospective study

et al. 2020

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Background: The occurrence of infectious complications characterizes the more severe forms of acute pancreatitis (AP) and is associated with high mortality. We investigated the effects of infection at different sites in patients with AP, including those with necrotizing pancreatitis (NP). Methods: We conducted a retrospective analysis of 285 patients who met the inclusion criteria for AP and were admitted to Tianjin Nankai Hospital between January 2016 and September 2019. According to the source of the culture positivity during hospitalization, patients were divided into four groups: sterile group(n = 148), pancreatic infection group(n = 65), extrapancreatic infection group(n = 22) and combined infection group(n = 50). The source of infection, microbiology, biochemical parameters and prognostic indicators were analyzed. Results: In terms of baseline characteristics, the four groups were similar in age, sex, aetiology, previous pancreatitis and diabetes. Compared with the severity of the disease in the other groups, the APACHE II scores(9.91 ± 4.65, 9.46 ± 5.05, respectively) and organ failure rate (40.9 and 50%, respectively)were higher in the extrapancreatic infection group and the combined infection group (P < 0.05). The frequency of surgical intervention and hospitalization time in patients with NP complicated with extrapancreatic infection was greatly increased (P < 0.05). Regarding the primary outcome, patients in the combined infection group had longer hospital stays (68.28 ± 51.80 vs 55.58 ± 36.24, P < 0.05) and higher mortality (24.0% vs 9.2%, P < 0.05) than patients in the pancreatic infection group. In addition, patients in the extrapancreatic infection group also showed high intensive care utilization (59.1%) and mortality rates (18.2%). Among the 137 AP patients with infection complications, 89 patients exhibited multidrug-resistant (MDR) microorganisms, and the mortality rate of patients with MDR bacterial infection was higher than that of patients with non-MDR bacterial infection (24.7% vs 3.6%, P = 0.001). Conclusion: Clinicians should be aware that extrapancreatic infection (EPI) significantly aggravates the main outcome in pancreatic infection patients. Infection with MDR bacteria is also associated with AP mortality.

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

Cited by 28 publications

References 23 publications

Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study

Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study

The impacts of infectious complications on outcomes in acute pancreatitis: a retrospective study

Increased Mortality from Extrapancreatic Infections in Hospitalized Patients with Acute Pancreatitis

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