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Fungal infection in acute necrotizing pancreatitis
M Grewe1, G G Tsiotos, E Luque de-Leon
1Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Background:
Anecdotal reports suggest that patients with fungal infection of necrotizing pancreatitis (NP) have worse outcomes than those with bacterial infection. Our aim was to compare the clinical course and outcomes of patients with NP infected with fungal versus nonfungal organisms.
Study Design:
Prospectively collected data on 57 patients with infected NP (1983-1995) were reviewed.
Results:
Seven patients (12%) developed fungal infection, and 50 (88%) developed bacterial infection. Groups had similar mean ages (60 versus 63 years) and APACHE-II scores on admission (9 each). The cause of NP was ERCP-induced in 3 of 7 with fungal infection versus 3 of 50 with bacterial infection. Patients with fungal infection had been treated with a mean of 4 different antibiotics for a mean of 23 days, and 4 of 7 (57%) required mechanical ventilation preoperatively. In addition, postoperative ICU stays were longer (20 versus 10 days), as were total hospital stays (59 versus 41 days). Mortality was higher with fungal infection; 3 of 7 patients (43%) died versus 10 of 50 patients (20%).
Conclusions:
Although NP presents with similar initial severity, patients with fungal infection of NP tend to have a more complicated course and worse outcomes compared with those with bacterial infection. Low-dose antifungal prophylaxis should be added to early management of NP.
Insights
Fungal infections in necrotizing pancreatitis (NP) patients lead to worse outcomes than bacterial infections. Early antifungal prophylaxis is recommended for managing NP to improve patient survival and clinical course.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Critical Care Medicine
Background:
- Necrotizing pancreatitis (NP) is a severe condition where fungal infections are anecdotally linked to poorer patient outcomes compared to bacterial infections.
- This study aimed to compare the clinical progression and outcomes of patients with NP experiencing fungal infections versus nonfungal (primarily bacterial) infections.
Purpose of the Study:
- To compare the clinical course and outcomes of patients with fungal versus bacterial infections in necrotizing pancreatitis.
- To evaluate the impact of fungal infection on patient morbidity and mortality in NP.
Main Methods:
- A prospective review of data from 57 patients diagnosed with infected NP between 1983 and 1995.
- Comparison of clinical characteristics, treatment, and outcomes between patients with fungal (n=7) and bacterial (n=50) NP.
Main Results:
- Fungal NP occurred in 12% of cases, with similar initial severity (APACHE-II scores) and causes (ERCP-induced) compared to bacterial NP.
- Patients with fungal NP experienced longer antibiotic treatment, higher rates of mechanical ventilation, and significantly longer intensive care unit (ICU) and hospital stays.
- Mortality was substantially higher in the fungal NP group (43%) compared to the bacterial NP group (20%).
Conclusions:
- Fungal infection in necrotizing pancreatitis is associated with a more complicated clinical course and worse patient outcomes, despite similar initial disease severity.
- The findings suggest that current management of NP may not adequately address fungal pathogens.
- Low-dose antifungal prophylaxis should be considered as an early component of NP management to potentially improve outcomes.