Characteristics of Infection with Candida Species inPatients with Necrotizing Pancreatitis

Abstract

This study focuses on the relevance of Candida infection (albicans and non-albicans) in patients with necrotizing pancreatitis. Altogether, 92 patients with infected pancreatic necrosis were reviewed for Candida infection. All patients underwent surgical necrosectomy for infected pancreatic necrosis. Data from patients with Candida growth in intraoperative smears were compared to those obtained from patients without Candida infection. There were 22 patients (24%) with Candida infection. Patients with or without Candida infection were comparable regarding age, gender, etiology, and severity scores at admission. Candida patients suffered a higher mortality (64% vs.19%, p = 0.0001) and experienced more systemic complications (3.2 +/- 1.6 vs. 2.1 +/- 1.4; p= 0.004) than patients without Candida. Preoperative antibiotics were given significantly longer prior to Candida infection (19.0 +/- 13.2 vs. 6.4 +/- 10.3 days; p < 0.0001). With regard to the concomitant spectrum of bacteria, solitary gram-negative infection was rare in Candida patients (5% vs. 43%, p =0.0006). The presence of Candida in patients with infected pancreatic necrosis is associated with increased mortality. Our data provide evidence that application of antibiotics contributes to the development of Candida infection and to changes in the bacterial spectrum of infected necrosis with an increase in the incidence of gram-positive infection.

Fungal Infection but Not Type of Bacterial Infection Is Associated with a High Mortality in Primary and Secondary Infected Pancreatic Necrosis

“…In both categories fungal infection was associated with an overwhelming mortality. An association between primary infected pancreatic necrosis and the extent of pancreatic necrosis was confirmed, in line with previous reports [11, 15, 29]. …”

“…Concerns have been raised over the increasing prevalence of multi-resistant organisms [15], but the present study found that mortality was not increased in patients with organisms that were resistant to the antibiotic prophylaxis used including multi-resistant bacteria. Gloor et al [14]found in 33 patients with infected necrosis that prophylactic antibiotic resistance (in 7 (21%) patients) and multi-resistant bacteria (in 3 (9%) patients) were independent prognostic factors of outcome.…”

“…This contrasts with the study by Beger et al [4]in 1986 prior to the routine use of antibiotics; they reported that 39 (87%) of 45 patients harboured only one organism, E. coli was the most common organism (in 24 (53%) patients) and 3 (7%) had fungal infection. More recently the same group [15]reported the microbiology of 92 patients with infected pancreatic necrosis treated between 1982 and 1997. Their policy was only to treat with antibiotics once infected necrosis was suspected or established.…”

“…Infection of pancreatic necrosis with Candida species [15, 23], Staphylococcus epidermidis [24], resistance to antibiotic prophylaxis [14]and Gram-negative infection [37]have been associated with a worse prognosis. Luiten et al [42]reported a 14-fold increased risk of death with Gram-negative sepsis compared to those with sterile necrosis, while those with Gram-positive infection had no increased risk.…”

“…In the 1980s pancreatic infection was predominately mono-microbial [4], mostly Gram-negative organisms from a biliary or enteric source [4]. In the last decade studies show poly-microbial infection and a shift to Gram-positive organisms [14, 15]. …”