title: Prevalence of primary fungal infections in necrotizing pancreatitis.
abstract: OBJECTIVE
  Prophylactic use of carbapenems (meropenem and imipenem) and other broad-spectrum antibiotics in necrotizing pancreatitis has been suggested as a risk factor for pancreatic fungal infections. The aim of our study was to determine the prevalence of primary fungal infections and the pattern of antibiotic use in necrotizing pancreatitis at our institution.
  
  
  METHODS
  Records on 689 consecutive patients with acute pancreatitis between 2000 and 2004 were reviewed. Necrotizing pancreatitis was identified by contrast-enhanced computed tomography (CT) scan. Data on antibiotic usage were collected and microbiologic data obtained from radiologic, endoscopic, and surgical interventions (pancreatic aspiration, drain placement or debridement) were reviewed for evidence of fungal infection. Pancreatic fungal infections were classified as primary if the positive culture was obtained at the time of initial intervention.
  
  
  RESULTS
  Among 64 patients with necrotizing pancreatitis, there were no cases of primary pancreatic fungal infections and 7 cases (11%) of secondary pancreatic fungal infections. Fifteen patients (23%) developed pancreatic bacterial infections. Among 62 patients with necrotizing pancreatitis in whom antibiotic exposure was known, 45% received carbapenems for a median duration of only 6 days, and 84% received non-carbapenem antibiotics for a median duration of 14 days.
  
  
  CONCLUSIONS
  Limited use and short duration of carbapenem therapy may be factors contributing to the absence of primary fungal infections in our study.
authors: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors: Tyler M
authors: TM
authors: Berzin
authors: Flavio G
authors: FG
authors: Rocha
authors: Edward E
authors: EE
authors: Whang
authors: Koenraad J
authors: KJ
authors: Mortele
authors: Stanley W
authors: SW
authors: Ashley
authors: Peter A
authors: PA
authors: Banks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015780:Carbapenems / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000209:etiology*; D019283:Pancreatitis, Acute Necrotizing / Q000188:drug therapy* / Q000382:microbiology; D015995:Prevalence
chemical_list: D015780:Carbapenems