Prevalence and outcome of fungal infection in patients with severe acute pancreatitis.
OBJECTIVE
To study the prevalence of risk factors and outcome of fungal infections in patients with severe acute pancreatitis.


METHODS
Fifty consecutive patients with severe acute pancreatitis were investigated for evidence of fungal infection by weekly culture of body fluids and aspirate from pancreatic/peripancreatic tissue and samples collected at necrosectomy. All patients were managed as per a standard protocol. Patients with documented fungal infection were treated with intravenous amphotericin or fluconazole. Data were analyzed using SPSS software (version 13), and risk factors for fungal infection and mortality were determined.


RESULTS
Fungal infection was documented in 18 (36%) of 50 patients with Candida albicans (the commonest species). The incidence of fungal infection steadily increased with increasing duration of hospital stay. Those with fungal infection more often had evidence of respiratory failure (P = 0.031) and hypotension (P = 0.031) at admission, prolonged hospital stay > 4 weeks (P = 0.034), longer duration of antibiotics (P = 0.003), received total parenteral nutrition (P = 0.005), and required mechanical ventilation (P = 0.001) in contrast to those without fungal infection. The logistic regression analysis found the independent risk factors for fungal infection to be antibiotic therapy for > 4 weeks and hypotension at hospitalization. Of the 18 patients with fungal infection, 13 were administered intravenous antifungals; eight of these patients survived, while the five who did not receive antifungals died.


CONCLUSIONS
Fungal infection was detected in 36% of our patients. The independent risk factors associated with it were hypotension at hospitalization and prolonged antibiotic therapy. Antifungal therapy improved their chances of survival.
Kochhar
Rakesh
R
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. dr_kochhar@hotmail.com
Ahammed
S K Mahiuddin
SK
Chakrabarti
Arunaloke
A
Ray
Pallab
P
Sinha
Saroj K
SK
Dutta
Usha
U
Wig
Jai Dev
JD
Singh
Kartar
K
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007022:Hypotension / Q000150:complications; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D016017:Odds Ratio; D010180:Pancreatectomy; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D010289:Parenteral Nutrition, Total; D015995:Prevalence; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole