title: Characteristics of infection with Candida species in patients 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.
authors.affiliation: Department of General Surgery, University of Ulm, Steinhoevelstrasse 9, 89075 Ulm, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Isenmann
authors.forename: Michael
authors.initials: M
authors.lastname: Schwarz
authors.forename: Bettina
authors.initials: B
authors.lastname: Rau
authors.forename: Matthias
authors.initials: M
authors.lastname: Trautmann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schober
authors.forename: Hans G
authors.initials: HG
authors.lastname: Beger
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000302:isolation & purification*; D002177:Candidiasis / Q000150:complications* / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010179:Pancreas / Q000382:microbiology / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents