The impacts of infectious complications on outcomes in acute pancreatitis: a retrospective study

Abstract

Background: The occurrence of infectious complications characterizes the more severe forms of acute pancreatitis (AP) and is associated with high mortality. We investigated the effects of infection at different sites in patients with AP, including those with necrotizing pancreatitis (NP). Methods: We conducted a retrospective analysis of 285 patients who met the inclusion criteria for AP and were admitted to Tianjin Nankai Hospital between January 2016 and September 2019. According to the source of the culture positivity during hospitalization, patients were divided into four groups: sterile group(n = 148), pancreatic infection group(n = 65), extrapancreatic infection group(n = 22) and combined infection group(n = 50). The source of infection, microbiology, biochemical parameters and prognostic indicators were analyzed. Results: In terms of baseline characteristics, the four groups were similar in age, sex, aetiology, previous pancreatitis and diabetes. Compared with the severity of the disease in the other groups, the APACHE II scores(9.91 ± 4.65, 9.46 ± 5.05, respectively) and organ failure rate (40.9 and 50%, respectively)were higher in the extrapancreatic infection group and the combined infection group (P < 0.05). The frequency of surgical intervention and hospitalization time in patients with NP complicated with extrapancreatic infection was greatly increased (P < 0.05). Regarding the primary outcome, patients in the combined infection group had longer hospital stays (68.28 ± 51.80 vs 55.58 ± 36.24, P < 0.05) and higher mortality (24.0% vs 9.2%, P < 0.05) than patients in the pancreatic infection group. In addition, patients in the extrapancreatic infection group also showed high intensive care utilization (59.1%) and mortality rates (18.2%). Among the 137 AP patients with infection complications, 89 patients exhibited multidrug-resistant (MDR) microorganisms, and the mortality rate of patients with MDR bacterial infection was higher than that of patients with non-MDR bacterial infection (24.7% vs 3.6%, P = 0.001). Conclusion: Clinicians should be aware that extrapancreatic infection (EPI) significantly aggravates the main outcome in pancreatic infection patients. Infection with MDR bacteria is also associated with AP mortality.

Predictors of Mortality and Drug Resistance Among Carbapenem-Resistant Enterobacteriaceae-Infected Pancreatic Necrosis Patients

“…Criteria of etiology were as follows: (1) hypertriglyceridemia: triglycerides > 5.6 mmol/l without other known cause; (2) gallstone: cholelithiasis or choledocholithiasis via contrast-enhanced computerized tomography; (3) alcoholism: regular consumption of alcohol (at least 50 g/day) [ 22 ]. The diagnoses of CRE IPN were based on: (1) contrast enhanced computed tomography; (2) positive microbiologic profiles from (peri)pancreatic necrosis obtained by the first therapeutic interventions [ 6 ]. Referrals were defined as patients transferred from lower-level hospitals 48 h after the AP occurred.…”

“…The crisis of MDR bacterial infection is more frequently occurring in developing countries including China where more than half of strains are MDR [4,5]. Most publications have shown that MDR bacterial infections are significantly associated with increased mortality among AP patients, and gram-negative bacteria have replaced the gram-positive isolates as the dominating bacteria in AP patients [3,[6][7][8][9]. Carbapenems are considered as last option for MDR gram-negative bacterial infections including Enterobacteriaceae.…”

Role of Interleukin-17 in Acute Pancreatitis

“…Currently, there is no effective therapeutic agent that reduces the risks and consequences of AP, which has a mortality rate of up to 30% ( 3 , 4 ). Over the past decade, immune system activation has been identified as a key trigger and regulator of inflammatory injury in the pancreas, affecting the extent of pancreatic necrosis, organ failure and disease deterioration ( 5 , 6 ). AP leads to overactivation of leukocytes and increased neutrophil metastasis to inflammation, with a consequent release of proinflammatory factors, including several forms of leukocyte interleukins, procalcitonin, transforming growth factor, and tumor necrosis factor ( 7 , 8 ).…”

Necrotizing pancreatitis due to Ascaris lumbricoides: Causes, diagnosis, and current treatment

“…El diagnóstico de la PNI puede ser difícil; la fiebre y la elevación de los marcadores inflamatorios son indicativos de infección, estos, en conjunto con los factores de riesgo para desarrollar PNI son útiles en la toma de decisiones clínicas sobre el manejo de la enfermedad (15) . El tratamiento actual recomendado en PNI y sepsis pancreática es la administración de antibiótico (16) .…”