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Difference in microbes contaminating pancreatic necrosis in biliary and alcoholic pancreatitis
1Department of Surgery, Tampere University Hospital, Finland.
Conclusion:
There are differences in the microbiology of infected pancreatic necrosis in alcoholic and biliary pancreatitis. One possible explanation may be different routes of contamination.
Background:
Infection is a severe complication in acute pancreatitis. Bacteria are found in 40-70% of all patients suffering from necrotizing pancreatitis. We investigated whether there were any differences in microbes isolated from pancreatic necrosis in biliary and alcoholic pancreatitis.
Methods:
Microbiological tests were conducted on necrosis taken at the operation for pancreatitis with the etiology of (group A) alcoholic pancreatitis (n = 47) and (group B) biliary pancreatitis (n = 23). Patients with simultaneous cholecystitis were excluded. The time from the first symptoms to the operation or the extent of necrosis did not differ between the groups.
Results:
Microbes were isolated more often in the cultures from group B than group A (17/23 = 74% vs 15/47 = 32%, p = 0.001). The most common were Gram-positive bacteria in group A and Gram-negative bacteria in group B. From the first week, from the onset of symptoms to the operation. Gram-negative bacteria were isolated significantly more often in the cultures from group B patients than from group A patients (8/10 = 80% vs 1/5 = 20%, p = 0.04). In multivariate analysis, we found that biliary pancreatitis was an independent risk factor (adds ratio 5.5, 95% confidence interval [CI] 0.59-52.10) of contamination of necrosis with Gram-negative bacteria.
Insights
Microbiology differs in infected pancreatic necrosis between alcoholic and biliary pancreatitis. Biliary pancreatitis shows higher rates of Gram-negative bacterial contamination, suggesting different infection routes.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Pathology
Background:
- Infection is a severe complication in acute pancreatitis, with bacteria found in 40-70% of necrotizing pancreatitis cases.
- Understanding microbial differences in pancreatitis etiology is crucial for effective treatment.
Purpose of the Study:
- To investigate differences in microbes isolated from pancreatic necrosis in patients with alcoholic versus biliary pancreatitis.
Main Methods:
- Microbiological analysis of pancreatic necrosis samples from 47 alcoholic pancreatitis patients (Group A) and 23 biliary pancreatitis patients (Group B).
- Exclusion of patients with simultaneous cholecystitis.
- Comparison of microbial findings between the two etiological groups.
Main Results:
- Microbes were isolated more frequently in biliary pancreatitis (74%) compared to alcoholic pancreatitis (32%).
- Gram-positive bacteria predominated in alcoholic pancreatitis, while Gram-negative bacteria were more common in biliary pancreatitis.
- Gram-negative bacteria were significantly more prevalent in biliary pancreatitis patients within the first week (80% vs 20%).
- Biliary pancreatitis was identified as an independent risk factor for Gram-negative bacterial contamination.
Conclusions:
- Significant differences exist in the microbiology of infected pancreatic necrosis based on etiology (alcoholic vs. biliary).
- The distinct microbial profiles suggest varying routes of contamination contribute to infection in these pancreatitis types.