title: Prevalence and outcome of fungal infection in patients with severe acute pancreatitis.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. dr_kochhar@hotmail.com
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kochhar
authors.forename: S K Mahiuddin
authors.initials: SK
authors.lastname: Ahammed
authors.forename: Arunaloke
authors.initials: A
authors.lastname: Chakrabarti
authors.forename: Pallab
authors.initials: P
authors.lastname: Ray
authors.forename: Saroj K
authors.initials: SK
authors.lastname: Sinha
authors.forename: Usha
authors.initials: U
authors.lastname: Dutta
authors.forename: Jai Dev
authors.initials: JD
authors.lastname: Wig
authors.forename: Kartar
authors.initials: K
authors.lastname: Singh
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole