Objectives: Intra-abdominal infection in severe acute pancreatitis (SAP) has significant morbidity and mortality; however, reports conflict on the outcome of patients with intra-abdominal fungal infection (IFI). We aimed to compare the morbidity and mortality of IFI compared with intra-abdominal bacterial infection (IBI) and no intra-abdominal infection (NII) in patients with SAP.
Methods: Medical records of 207 consecutive patients admitted with SAP (per the Atlanta classification) to the Mayo Clinic (Rochester, Minnesota) between 1992 and 2001 were reviewed. All intra-abdominal microbiology cultures from pancreatic and peri-pancreatic necrosis, abscess, and/or pseudocyst obtained at operation, endoscopic necrosectomy or computed tomography-guided aspiration were reviewed. Patients were divided into three groups-IFI, IBI, and NII. Primary fungal infections were those for which there had been no prior abdominal interventions, and secondary infections were those that followed a prior intervention. Our main outcome was in-hospital mortality and secondary outcomes included the presence of organ failure (OF), need for surgical intervention, need for intensive care unit (ICU) care, and duration of hospitalization.
Results: The groups were similar in terms of baseline characteristics, use of prophylactic antibiotics, use of enteral/parenteral nutrition, development of necrosis, and peripancreatic fluid collections. Fifty-two percent of patients had an intra-abdominal infection; all of these developed bacterial infections and 30 (15%) developed concomitant fungal infections. There were 7 primary fungal infections and 23 secondary infections-no important outcome differences were noted between these groups. Compared with patients with IBI, patients with IFI had longer hospital (63 vs. 37 days, P<0.01) and ICU (28 vs. 9 days, P<0.01) stays and higher rates of OF (73 vs. 47%, P<0.04), but similar mortality rates (20 vs. 17%, P0.41). Multivariate analysis revealed the presence of OF (odds ratio (OR) 2.4, 95% confidence interval (CI) 1,7) and the need for ICU care (OR 4.3, 95% CI 1,28) to be associated with IFI.
Conclusions: Patients with SAP and IFI suffered greater in-hospital morbidity than did patients with IBI alone. Concomitant fungal infection, however, did not increase the in-hospital mortality rate.