title: Bacteriology of infection in severe acute pancreatitis.
abstract: BACKGROUND
  Severe acute pancreatitis is associated with high mortality with infectious complications being the most common cause of mortality.
  
  
  OBJECTIVE
  To analyze the prevalence and characteristics of pancreatic and extrapancreatic infection in patients with severe acute pancreatitis.
  
  
  METHODS
  Prospective study over a one-year period.
  
  
  METHODS
  Fifty-one consecutive patients with severe acute pancreatitis. Setting Tertiary care centre, Northern India.
  
  
  METHODS
  The presence of pancreatic and extrapancreatic infections were noted in consecutive patients with severe acute pancreatitis and their effect on disease outcome was assessed.
  
  
  RESULTS
  Pancreatic infection was noted in 19 (37.3%) patients; 14 (27.5%) patients had monomicrobial and 5 (9.8%) patients had polymicrobial infections. In the first week of hospitalization, all positive 6/6 (100%) cultures grew Escherichia coli, in the second week 5/8 (62.5%) grew Escherichia coli while after the second week, 2/5 (40.0%) cultures grew Escherichia coli. A total of 32 (62.7%) patients had evidence of extrapancreatic infections, with 53 positive cultures. Fifteen (29.4%) patients had monomicrobial infections while 17 (33.3%) had polymicrobial infections. The most common site was blood together with intravenous site with 21 positive cultures in 16 patients. Staphylococcus aureus was most commonly isolated in the blood cultures. There was a statistically significant increase in mortality with pancreatic (P=0.003) and extrapancreatic (P=0.041) infections. The antibiotic sensitivity pattern showed that most of the bacteria were sensitive to beta lactum antibiotics, aminoglycosides and imipenem.
  
  
  CONCLUSIONS
  Pancreatic infections are more often monomicrobial with a shift from gram-negative to gram-positive as the pancreatitis progressed. Extrapancreatic infections are more often polymicrobial; most commonly, the blood stream is invaded by gram-positive bacteria.
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Mohd T
authors.initials: MT
authors.lastname: Noor
authors.forename: Yellapu
authors.initials: Y
authors.lastname: Radhakrishna
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kochhar
authors.forename: Pallab
authors.initials: P
authors.lastname: Ray
authors.forename: Jai Dev
authors.initials: JD
authors.lastname: Wig
authors.forename: Saroj K
authors.initials: SK
authors.lastname: Sinha
authors.forename: Kartar
authors.initials: K
authors.lastname: Singh
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002511:Cephalosporins / Q000494:pharmacology / Q000627:therapeutic use; D015897:Comorbidity; D004926:Escherichia coli / Q000187:drug effects; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015378:Imipenem / Q000494:pharmacology / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010195:Pancreatitis / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D015378:Imipenem