title: Spectrum of microorganisms in infected walled-off pancreatic necrosis - impact on organ failure and mortality.
abstract: OBJECTIVE
  Data on the microbial spectrum in infected pancreatic necrosis are scarce. Only few studies have addressed this issue in a larger, consecutive group of patients treated by a standardized algorithm. Since 2005 endoscopic, transmural drainage and necrosectomy (ETDN) has been the treatment of choice for walled-off necrosis in our centre. The present study evaluated the microbial spectrum of infected pancreatic necrosis and the possible relationship between infected necrosis, organ failure, and mortality. Furthermore, we investigated whether the aetiology of pancreatitis, use of external drainage, and antibiotic treatment influenced the microbial findings.
  
  
  METHODS
  Retrospective review of medical charts on 78 patients who underwent ETDN in our tertiary referral centre between November 2005 and November 2011.
  
  
  RESULTS
  Twenty-four patients (31%) developed one or more organ failures, 23 (29%) needed treatment in the intensive care unit (ICU), and 9 (11%) died during hospital admission. The prevailing microbial findings at the index endoscopy were enterococci (45%), enterobacteriaceae (42%), and fungi (22%). There was a significant association between the development of organ failure (p < 0.001), need of treatment in ICU (p < 0.002), in-hospital mortality (p = 0.039) and infected necrosis at the time of index endoscopy. Enterococci (p < 0.0001) and fungi (p = 0.01) were found more frequently in patients who died during admission as compared to survivors.
  
  
  CONCLUSIONS
  Different microbes in pancreatic necrosis may influence the prognosis. We believe that a detailed knowledge on the microbial spectrum in necrotizing pancreatitis may be utilized in the treatment to improve the outcome.
authors.affiliation: Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark. Electronic address: pns@dadlnet.dk.
authors.forename: Palle N
authors.initials: PN
authors.lastname: Schmidt
authors.affiliation: Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark.
authors.forename: Stine
authors.initials: S
authors.lastname: Roug
authors.affiliation: Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark.
authors.forename: Erik F
authors.initials: EF
authors.lastname: Hansen
authors.affiliation: Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Denmark.
authors.forename: Jenny D
authors.initials: JD
authors.lastname: Knudsen
authors.affiliation: Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark.
authors.forename: Srdan
authors.initials: S
authors.lastname: Novovic
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000382:microbiology* / Q000401:mortality* / Q000601:surgery; D003422:Critical Care; D004322:Drainage; D004724:Endoscopy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D009181:Mycoses / Q000150:complications / Q000382:microbiology* / Q000401:mortality* / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000382:microbiology* / Q000401:mortality* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Endoscopic treatment; Infected pancreatic necrosis; Microbial findings; Mortality; Organ failure