title: Fungal infection but not type of bacterial infection is associated with a high mortality in primary and secondary infected pancreatic necrosis.
abstract: BACKGROUND
  Knowledge of microbiology in the prognosis of patients with necrotizing pancreatitis is incomplete.
  
  
  OBJECTIVE
  This study compared outcomes based on primary and secondary infection after surgery for pancreatic necrosis.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  Whether associated with primary or secondary infected pancreatic necrosis, fungal but not bacterial infection was associated with a high mortality.
authors.affiliation: Department of Surgery, Royal Liverpool University Hospital, UCD, Daulby Street, Liverpool, L69 3GA, UK.
authors.forename: S
authors.initials: S
authors.lastname: Connor
authors.forename: N
authors.initials: N
authors.lastname: Alexakis
authors.forename: T
authors.initials: T
authors.lastname: Neal
authors.forename: M
authors.initials: M
authors.lastname: Raraty
authors.forename: P
authors.initials: P
authors.lastname: Ghaneh
authors.forename: J
authors.initials: J
authors.lastname: Evans
authors.forename: M
authors.initials: M
authors.lastname: Hughes
authors.forename: P
authors.initials: P
authors.lastname: Rowlands
authors.forename: C J
authors.initials: CJ
authors.lastname: Garvey
authors.forename: R
authors.initials: R
authors.lastname: Sutton
authors.forename: J P
authors.initials: JP
authors.lastname: Neoptolemos
mesh_terms: D001424:Bacterial Infections / Q000401:mortality / Q000601:surgery; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D009181:Mycoses / Q000401:mortality* / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000382:microbiology* / Q000401:mortality* / Q000601:surgery; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome