Candida Infection of Local Necrosis in Severe Acute Pancreatitis Is Associated With Increased Mortality

Götzinger, P.; Wamser, P; Barlan, Murat; Sautner, Thomas; Jakesz, R.; Függer, R.

doi:10.1097/00024382-200014030-00014

Cited by 67 publications

(62 citation statements)

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“…Several reports have indicated that gender has no prognostic significance (31,46,73,83,87,91,165). Furthermore, etiology has also been shown to have no prognostic significance (46,53,60,61,75,83,87,91,168) other than one report that indicated that patients with alcoholic pancreatitis in their first episode of pancreatitis have a greater need for intubation and greater prevalence of pancreatic necrosis (74).…”

Section: Diagnostic Guideline I: Look For Risk Factors Of Severity Atmentioning

confidence: 99%

“…However, the extent of necrosis may not be as important in the morbidity and mortality of necrotizing pancreatitis as was once thought. While some series have shown a correlation between extent of necrosis and prevalence of organ failure (66,69,148,161), others have not (50,83,111); similarly, while some series have shown a correlation between the extent of necrosis and the prevalence of infected necrosis (117,161,175), others have not (83,91,111); while one recent study has shown a correlation of extent of necrosis with mortality (161), others have not (83,128,138).…”

Section: Level Of Evidence: IIImentioning

confidence: 99%

“…This risk appears to correlate with prolonged use of antibiotic therapy (62)(63)(64). While the prevalence of fungal infection among patients with necrotizing pancreatitis in recent studies has been 9% (range 8-35%) (62,64,65,91,110,119,187), it remains unclear whether mortality is significantly higher when there is superimposed fungal infection. Some reports indicate a greater mortality (63,65,91,116), whereas others do not (62,64,115,119,187).…”

Section: Level Of Evidence: IIImentioning

confidence: 99%

“…Approximately 33% of patients with necrotizing pancreatitis develop infected necrosis, usually after 10 days of illness (62,66,68,83,91,111,113,117,118,120,121,147,159,169,170). Most patients with infected necrosis have systemic toxicity (including fever and leukocytosis) that is either documented from the time of admission or develops at some time after admission.…”

Section: Level Of Evidence: IIImentioning

confidence: 99%

“…First, there have been several retrospective reports suggesting that a delay in surgical necrosectomy and at times a total avoidance of surgery results in less morbidity and mortality than early surgical debridement (55,60,68,(107)(108)(109)138). Secondly, when sterile necrosis is debrided surgically, a common sequela is the development of infected necrosis and the need for additional surgery (55,91,112,138,160). In at least one report, patients so treated had a very high mortality (138).…”

Section: Treatment Guideline Vi: Treatment Of Sterile Necrosismentioning

confidence: 99%

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Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,665

980

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Section: Diagnostic Guideline I: Look For Risk Factors Of Severity Atmentioning

confidence: 99%

Section: Level Of Evidence: IIImentioning

confidence: 99%

Section: Level Of Evidence: IIImentioning

confidence: 99%

Section: Level Of Evidence: IIImentioning

confidence: 99%

Section: Treatment Guideline Vi: Treatment Of Sterile Necrosismentioning

confidence: 99%

See 3 more Smart Citations

Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,665

980

View full text Add to dashboard Cite

Emergence of Antibiotic Resistance in Infected Pancreatic Necrosis

Waele

Vogelaers²,

Hoste³

et al. 2004

Arch Surg

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Background: Overall, the use of antibiotics in the treatment of patients with severe acute pancreatitis has increased owing to the use of antibiotic prophylaxis. Hypothesis: The incidence of antibiotic-resistant (AB-R) bacteria in infected pancreatitis is related to prolonged antibiotic treatment and may affect outcome. Design: Case series. Setting: Fifty-six-bed intensive care unit of a tertiary care center. Patients: Forty-six consecutive patients with infected pancreatic necrosis. Main Outcome Measures: Occurrence rate of AB-R organisms in pancreatic infection, overall duration of antibiotic treatment prior to infection, and mortality, defined as inhospital mortality. Results: Infection with AB-R microorganisms was found in 24 (52%) of 46 patients. Primary infection was present in 7 patients; in 21 patients, nosocomial surinfection with AB-R organisms occurred. Patients with AB-R infections were treated with antibiotics for a longer period (24 vs 15 days, PϽ.05), while disease severity and the incidence of organ failure were not statistically significantly different. The intensive care unit stay was significantly longer in patients with AB-R infections (23 vs 31 days, P=.02). Mortality was not statistically significantly different in patients with AB-R infections (37% vs 28%, P=.23). Conclusions: The occurrence rate of infections with AB-R organisms in our patients with severe acute pancreatitis was high and was associated with a longer intensive care unit stay, but no increased mortality could be demonstrated. The duration of antibiotic treatment was increased in patients in whom AB-R infections developed.

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Timing of Surgical Intervention in Necrotizing Pancreatitis

Verwer²,

et al. 2007

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To determine the effect of timing of surgical intervention for necrotizing pancreatitis. Design: Retrospective study of 53 patients and a systematic review. Setting: A tertiary referral center. Main Outcome Measure: Mortality. Results: Median timing of the intervention was 28 days. Eighty-three percent of patients had infected necrosis and 55% had preoperative organ failure. The mortality rate was 36%. Sixteen patients were operated on within 14 days of initial admission, 11 patients from day 15 to 29, and 26 patients on day 30 or later. This latter group received preoperative antibiotics for a longer period (PϽ.001), and Candida species and antibiotic-resistant organisms were more often cultured from the pancreatic or peripancreatic necrosis in these patients (P=.02). The 30-day group also had the lowest mortality (8% vs 75% in the 1 to 14-days group and 45% in the 15 to 29days group, PϽ.001); this difference persisted when outcome was stratified for preoperative organ failure. During the second half of the study, necrosectomy was further postponed (43 vs 20 days, P = .06) and mortality decreased (22% vs 47%, P=.09). We also reviewed 11 studies with a total of 1136 patients. Median surgical patient volume was 8.3 patients per year (range, 5.3-15.6), median timing of surgical intervention was 26 days (range, 3-31), and median mortality was 25% (range, 6%-56%). We observed a significant correlation between timing of intervention and mortality (R=−0.603; 95% confidence interval, −2.10 to −0.02; P =.05). Conclusion: Postponing necrosectomy until 30 days after initial hospital admission is associated with decreased mortality, prolonged use of antibiotics, and increased incidence of Candida species and antibioticresistant organisms.

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Candida Infection of Local Necrosis in Severe Acute Pancreatitis Is Associated With Increased Mortality

Cited by 67 publications

References 0 publications

Practice Guidelines in Acute Pancreatitis

Practice Guidelines in Acute Pancreatitis

Emergence of Antibiotic Resistance in Infected Pancreatic Necrosis

Timing of Surgical Intervention in Necrotizing Pancreatitis

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