Pancreatic Fungal Infection in Patients With Necrotizing Pancreatitis: A Systematic Review and Meta-analysis

Area of Science:

• Medical Mycology
• Gastroenterology
• Critical Care Medicine

Background:

• Infected pancreatic necrosis is a major cause of death in necrotizing pancreatitis (NP).
• Pancreatic fungal infection (PFI) is frequently observed in NP patients, but its clinical impact remains unclear.

Purpose of the Study:

• To determine the incidence of fungal infection in NP.
• To evaluate the impact of PFI on mortality and other clinical outcomes in NP patients.

Main Methods:

• A systematic literature search was conducted across Medline, Embase, and Cochrane Library.
• Included were 22 prospective and retrospective studies with 2151 NP patients, focusing on fungal isolation from necrotic tissue and mortality data.
• Bias was assessed using the Newcastle Ottawa Scale and Joanna Briggs Institute's critical appraisal tool.

Main Results:

• The incidence of PFI in NP was 26.6% (572/2151).
• PFI was significantly associated with higher in-hospital mortality (OR=3.95), increased ICU admission rates (OR=3.95), and longer hospital stays (mean difference=22.99 days).
• Patients with PFI also showed higher rates of prophylactic antibacterial use and longer antibacterial therapy duration.

Conclusions:

• Pancreatic fungal infection is prevalent in NP and linked to worse clinical outcomes, including increased mortality and resource utilization.
• Further research is warranted to elucidate PFI pathophysiology and explore preemptive antifungal therapies.