title: A systematic review of the extra-pancreatic infectious complications in acute pancreatitis.
abstract: OBJECTIVE
  Extra-pancreatic infectious complications in acute pancreatitis increase morbidity, but their incidence and association with infected pancreatic necrosis is unknown. Half of bacterial cultures of pancreatic necrosis are of non-enteric origin, raising the possibility of other sources of infection. The aim of this systematic review was to assess the incidence of extra-pancreatic infectious complications in acute pancreatitis, their timing, and relation to severity of pancreatitis and mortality.
  
  
  METHODS
  A systematic review was performed using Ovid MEDLINE, Embase and Cochrane Libraries, following PRISMA guidelines. Search terms were "Pancreatitis" AND "Infection" AND ("Complication" OR "Outcome").
  
  
  RESULTS
  19 studies with 1741 patients were included. Extra-pancreatic infectious complication incidence was 32% (95% CI 23-41%), with the commonest being respiratory infection (9.2%) and bacteraemia (8.4%). Extra-pancreatic infectious complications were not associated with the predicted severity or the mortality of acute pancreatitis. Only 3 studies reported a relation of timing between extra-pancreatic and pancreatic infectious complications.
  
  
  CONCLUSIONS
  This is the first systematic review to evaluate the incidence of extra-pancreatic infectious complications in acute pancreatitis, which a third of patients with acute pancreatitis will develop. Implications are vigilance and prompt treatment of extra-pancreatic infection, to reduce possibility of progression to infected pancreatic necrosis.
authors.affiliation: The Department of Surgery, The University of Auckland, Auckland, New Zealand. Electronic address: l.brown@auckland.ac.nz.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Brown
authors.affiliation: The Department of Surgery, The University of Auckland, Auckland, New Zealand. Electronic address: toddnz@gmail.com.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Hore
authors.affiliation: The Department of Surgery, The University of Auckland, Auckland, New Zealand. Electronic address: a.phillips@auckland.ac.nz.
authors.forename: Anthony R J
authors.initials: AR
authors.lastname: Phillips
authors.affiliation: The Department of Surgery, The University of Auckland, Auckland, New Zealand. Electronic address: j.windsor@auckland.ac.nz.
authors.forename: John A
authors.initials: JA
authors.lastname: Windsor
authors.affiliation: The Department of Surgery, The University of Auckland, Auckland, New Zealand. Electronic address: m.petrov@auckland.ac.nz.
authors.forename: Maxim S
authors.initials: MS
authors.lastname: Petrov
mesh_terms: D000208:Acute Disease; D006801:Humans; D015994:Incidence; D007239:Infections / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D010195:Pancreatitis / Q000150:complications* / Q000401:mortality; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications; D016896:Treatment Outcome
keywords: Complications; Infection; Meta-analysis; Outcome; Pancreatitis; Severity