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Candidemia indicates poor outcome in patients with infected pancreatic necrosis
Caihong Ning1,2,3, Shuai Zhu1,2,3, Qin Wei1,2,3
1Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, China.
Background:
Intra-abdominal fungal infection (AFI) and candidemia are common in patients with acute pancreatitis (AP), but with limited and conflicting reports on their clinical impacts. This study aims to evaluate the clinical impacts of AFI and candidemia in infected pancreatic necrosis (IPN).
Methods:
A single-centre, prospective cohort including 235 consecutive patients with IPN between January 2010 and September 2020 was analysed to study the clinical impacts of AFI and candidemia.
Results:
Of the 235 patients with IPN, 69 patients (29.4%) developed AFI and 13 patients (5.5%) developed candidemia. AFI was associated with higher intestinal leakage rate (27.5% vs 12.7%, P = .006), higher pancreatic fistula rate (53.6% vs 34.3%, P = .006) and longer hospital stays (72 vs 58 days, P = .003), but with similar mortality rate compared with patients without AFI (23.2% vs 24.7%, P = .806). However, candidemia was associated with significantly higher mortality rate compared with patients without candidemia (69.2% vs 21.6%, P < .001). Patients with candidemia had higher rate of multiple organ failure and AFI (69.2% vs 36.5%, P = .018; 69.2% vs 27.0%, P = .001, respectively). Multivariable analysis showed that age ≥ 50 years (OR = 2.8; 95% CI, 1.3-5.8; P = .007), severe category (OR = 11.2; 95% CI, 3.5-35.7; P < .001), multidrug-resistant organisms infection (OR = 2.5; 95% CI, 1.0-6.2; P = .039), candidemia (OR = 11.8; 95% CI, 2.5-56.5; P = .002), step-down surgical approach (OR = 3.2; 95% CI, 1.5-7.0; P = .004) were the independent predictors associated with higher mortality in IPN patients.
Conclusion:
Although AFI did not increase the mortality of IPN, patients with candidemia carried significantly higher mortality.
Insights
Intra-abdominal fungal infection (AFI) in acute pancreatitis (AP) patients increased complications but not mortality. Candidemia, however, significantly elevated mortality rates in infected pancreatic necrosis (IPN) patients.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Critical Care Medicine
Background:
- Intra-abdominal fungal infection (AFI) and candidemia are frequent complications in acute pancreatitis (AP).
- Existing data on their clinical impact in infected pancreatic necrosis (IPN) is limited and conflicting.
- This study investigates the specific clinical effects of AFI and candidemia in IPN patients.
Purpose of the Study:
- To evaluate the clinical impact of intra-abdominal fungal infection (AFI) in patients with infected pancreatic necrosis (IPN).
- To assess the clinical impact of candidemia in patients with infected pancreatic necrosis (IPN).
Main Methods:
- A prospective cohort study was conducted at a single center.
- 235 consecutive patients diagnosed with infected pancreatic necrosis (IPN) between January 2010 and September 2020 were analyzed.
- The study focused on comparing outcomes between patients with and without AFI and candidemia.
Main Results:
- Intra-abdominal fungal infection (AFI) was observed in 29.4% of IPN patients, associated with increased intestinal leakage, pancreatic fistula, and longer hospital stays, but not mortality.
- Candidemia occurred in 5.5% of IPN patients and was significantly linked to higher mortality rates (69.2% vs. 21.6%).
- Candidemia patients also showed higher rates of multiple organ failure and concurrent AFI. Independent predictors for mortality included age ≥50, severe IPN, multidrug-resistant infections, candidemia, and step-down surgery.
Conclusions:
- Intra-abdominal fungal infection (AFI) does not appear to increase mortality in infected pancreatic necrosis (IPN) patients.
- Candidemia is a significant risk factor associated with substantially higher mortality in IPN patients.
- Early identification and management of candidemia are crucial for improving outcomes in IPN.
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