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Risk Factors Associated with the Emergence of Multidrug-Resistant Bacteria and Fungal Infections in Walled-Off
Michael Fernandez Y Viesca1, Alia Hadefi1, Lukas Otero Sanchez1
1Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium.
Background:
Infected pancreatic necrosis (IPN) is a serious complication of moderate-to-severe acute pancreatitis (AP), associated with high morbidity, intensive care unit (ICU) admission, organ failure, and mortality. Initial management relies on antibiotics and drainage of walled-off necrosis (WON). In the context of increasing multidrug-resistant (MDR) bacteria, identifying risk factors for MDR emergence is crucial. The impact of fungal infections (FIs) on outcomes also remains unclear. This study aimed to identify risk factors associated with the emergence of MDR bacteria and FIs during intervention for IPN.
Methods:
This retrospective study included 71 consecutive patients undergoing intervention for suspected IPN or symptomatic WON.
Results:
At first intervention, IPN was confirmed in 52 patients (73%), MDR bacteria in 19 (27%), extensively drug-resistant (XDR) bacteria in 4 (5.6%), and FI in 21 (30%). After all interventions, MDR/XDR bacteria and fungi were detected in 25 (35%)/11 (15.5%) and 42 (59%) patients, respectively. Independent risk factors for MDR emergence were the number of antibiotic changes (b, 1.70; 95% CI 1.18-2.43; p = 0.004) and need for nutritional support (NS) (b, 5.69; 95% CI 1.52-20.50; p = 0.010). No independent factor was associated with FI. The 180-day mortality did not differ across groups. The 90-day cumulative ICU admission rate was higher in IPN vs. non-IPN (63.1% vs. 29.4%, p = 0.030) and in MDR vs. non-MDR (72.2% vs. 37.1%, p = 0.005).
Conclusions:
Antibiotic changes and NS were independently associated with MDR emergence in IPN. No independent factors were linked to FI. ICU admission was significantly higher in IPN and MDR cases.
Insights
Antibiotic changes and nutritional support increase multidrug-resistant (MDR) bacteria risk in infected pancreatic necrosis (IPN). Fungal infections showed no specific risk factors, but MDR cases had higher ICU admissions.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Critical Care Medicine
Background:
- Infected pancreatic necrosis (IPN) is a severe complication of acute pancreatitis (AP), leading to high morbidity and mortality.
- Management involves antibiotics and drainage, but multidrug-resistant (MDR) bacteria and fungal infections (FIs) pose growing challenges.
- Risk factors for MDR emergence and the impact of FIs in IPN require further investigation.
Purpose of the Study:
- To identify independent risk factors for the emergence of MDR bacteria during intervention for IPN.
- To explore risk factors associated with fungal infections (FIs) in patients with IPN.
- To analyze the impact of MDR bacteria and FIs on patient outcomes, including intensive care unit (ICU) admission.
Main Methods:
- A retrospective study of 71 consecutive patients undergoing intervention for suspected IPN or symptomatic walled-off necrosis (WON).
- Analysis of microbial data (MDR bacteria, extensively drug-resistant (XDR) bacteria, and FIs) at initial and subsequent interventions.
- Statistical analysis to identify independent risk factors for MDR emergence and FIs, and to compare outcomes across patient groups.
Main Results:
- IPN was confirmed in 73% of patients; MDR/XDR bacteria and FIs were detected in 35%/15.5% and 59% of patients, respectively, after interventions.
- Independent risk factors for MDR emergence included the number of antibiotic changes (p=0.004) and the need for nutritional support (NS) (p=0.010).
- No independent risk factors were associated with FIs. ICU admission rates were significantly higher in IPN (63.1%) and MDR (72.2%) cases compared to non-IPN and non-MDR groups, respectively.
Conclusions:
- The number of antibiotic changes and the need for nutritional support are independently associated with MDR bacterial emergence in IPN.
- No specific independent risk factors were identified for fungal infections in this patient cohort.
- Higher rates of ICU admission were observed in patients with IPN and those infected with MDR bacteria, highlighting the severity of these conditions.
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