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

Lu, Jiongdi; Cao, Feng; Ding, Yixuan; Wu, Yougui; Guo, Yulin; Li, Fēi

doi:10.3748/wjg.v25.i34.5162

Cited by 44 publications

(50 citation statements)

References 26 publications

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“…The diagnosis of INP was based on the presence of extraluminal gas on enhanced CT and positive culture from pancreatic necrosis obtained by first puncture or operation [18].…”

Section: Infected Necrotizing Pancreatitis (Inp)mentioning

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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“…The diagnosis of INP was based on the presence of extraluminal gas on enhanced CT and positive culture from pancreatic necrosis obtained by first puncture or operation [18].…”

Section: Infected Necrotizing Pancreatitis (Inp)mentioning

confidence: 99%

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

et al. 2020

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“…Acute pancreatitis (AP) is an inflammatory disorder of the exocrine pancreas with high morbidity and mortality if associated with local and systemic complications [ 1 , 2 ]. Most patients present with mild self-limited AP with a good prognosis [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Plasmatic Oxidative and Metabonomic Profile of Patients with Different Degrees of Biliary Acute Pancreatitis Severity

et al. 2021

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(1) Background: Acute pancreatitis (AP) is an inflammatory process of the pancreas with variable involvement of the pancreatic and peripancreatic tissues and remote organ systems. The main goal of this study was to evaluate the inflammatory biomarkers, oxidative stress (OS), and plasma metabolome of patients with different degrees of biliary AP severity to improve its prognosis. (2) Methods: Twenty-nine patients with biliary AP and 11 healthy controls were enrolled in this study. We analyzed several inflammatory biomarkers, multifactorial scores, reactive oxygen species (ROS), antioxidants defenses, and the plasma metabolome of biliary AP and healthy controls. (3) Results: Hepcidin (1.00), CRP (0.94), and SIRI (0.87) were the most accurate serological biomarkers of AP severity. OS played a pivotal role in the initial phase of AP, with significant changes in ROS and antioxidant defenses relating to AP severity. Phenylalanine (p < 0.05), threonine (p < 0.05), and lipids (p < 0.01) showed significant changes in AP severity. (4) Conclusions: The role of hepcidin and SIRI were confirmed as new prognostic biomarkers of biliary AP. OS appears to have a role in the onset and progression of the AP process. Overall, this study identified several metabolites that may predict the onset and progression of biliary AP severity, constituting the first metabonomic study in the field of biliary AP.

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“…It may arise at any time during the clinical course but peak incidence is between the 2nd and the 4th week after presentation [2]. Gram-negative bacteria are the main infectious species isolated, the most common of which are Escherichia coli and Pseudomonas aeruginosa [9]. Recently, a trend towards increasing incidence of Gram-positive and multi-resistant bacteria has been demonstrated [10,11].…”

Section: Pancreatic Necrosis and Pseudocystsmentioning

confidence: 99%

Surgical and Interventional Management of Complications Caused by Pancreatitis

Stecca¹,

Pauletti²,

Bonariol³

et al. 2022

Recent Advances in Pancreatitis

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Acute pancreatitis has a broad clinical spectrum: from mild, self-limited disease to fulminant illness resulting in multi-organ failure leading to a prolonged clinical course with up to 30% mortality in case of infected necrosis. Management of local complications such as pseudocysts and walled-off necrosis may vary from clinical observation to interventional treatment procedures. Gram negative bacteria infection may develop in up to one-third of patients with pancreatic necrosis leading to a clinical deterioration with the onset of the systemic inflammatory response syndrome and organ failure. When feasible, an interventional treatment is indicated. Percutaneous or endoscopic drainage approach are the first choices. A combination of minimally invasive techniques (step-up approach) is possible in patients with large or multiple collections. Open surgical treatment has been revised both in the timing and in the operating modalities in the last decades. Since 1990s, the surgical treatment of infected necrosis shifted to a more conservative approach. Disruption of the main pancreatic duct is present in up to 50% of patients with pancreatic fluid collections. According to the location along the Wirsung, treatment may vary from percutaneous drainage, endoscopic retrograde pancreatography with sphincterectomy or stenting to traditional surgical procedures. Patients may suffer from vascular complications in up to 23% of cases. Tissue disruption provoked by lipolytic and proteolytic enzymes, iatrogenic complications during operative procedures, splenic vein thrombosis, and pseudoaneurysms are the pathophysiological determinants of bleeding. Interventional radiology is the first line treatment and when it fails or is not possible, an urgent surgical approach should be adopted. Chylous ascites, biliary strictures and duodenal stenosis are complications that, although uncommon and transient, may have different treatment modalities from non-operative, endoscopic to open surgery.

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

Cited by 44 publications

References 26 publications

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

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

Plasmatic Oxidative and Metabonomic Profile of Patients with Different Degrees of Biliary Acute Pancreatitis Severity

Surgical and Interventional Management of Complications Caused by Pancreatitis

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