Fungal Infection but Not Type of Bacterial Infection Is Associated with a High M

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Original Paper

Fungal Infection but Not Type of Bacterial Infection Is Associated

with a High Mortality in Primary and Secondary Infected Pancreatic

Necrosis

S. Connora, N. akisa, T. Nealb, M. Raratya, P. Ghaneha, J.

c, M. c, P. Rowlandsc, C.J. Garveyc, R. Suttona, J.P.

Neoptolemosa

Departments of

aSurgery,

bMicrobiology

and

cRadiology, Royal Liverpool University Hospital, Liverpool, UK

Address of Corresponding Author

Digestive Surgery 2004;21:297-304 (DOI: 10.1159/000080884)

Abstract

Introduction: Knowledge of microbiology in the prognosis of patients

with necrotizing pancreatitis is incomplete. Aim: This study

compared outcomes based on primary and secondary infection after

surgery for pancreatic necrosis. Method: From a limited prospective

database of pancreatic necrosectomy, a retrospective case note

review was performed (October 1996 to April 2003). Results: 55 of 73

patients had infected pancreatic necrosis at the first necrosectomy.

25 of 47 patients had resistant bacteria to prophylactic antibiotics

(n = 21) or did not receive prophylactic antibiotics (n = 4), but

this was not associated with a higher mortality (9 of 25) compared

to those with sensitive organisms (4 of 22). Patients with fungal

infection (n = 6) had a higher initial median (95% CI) APACHE II

score compared to those without (11 (9-13) verus 8.5 (7-10), p =

0.027). Five of six patients with fungal infection died compared to

13 of 47 who did not (p = 0.014). With the inclusion of secondary

infections 21 (32%) of 66 patients had fungal infection with 10

(48%) deaths compared to 11 (24%) of 45 patients without fungal

infection (p = 0.047). Conclusion: Whether associated with primary

or secondary infected pancreatic necrosis, fungal but not bacterial

infection was associated with a high mortality.

Copyright © 2004 S. Karger AG, Basel

Author Contacts

Prof. J.P. Neoptolemos

Department of Surgery, Royal Liverpool University Hospital

5th floor UCD, Daulby Street

Liverpool, L69 3GA (UK)

Tel. +44 151 706 4177, Fax +44 151 706 5826, E-Mail

j.p.neoptolemos@...

Article Information

Received: December 11, 2003

Accepted: June 7, 2004

Published online: September 13, 2004

Number of Print Pages : 8

Number of Figures : 0, Number of Tables : 5, Number of References :

45

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