title: Risk factors for the development of intra-abdominal fungal infections in acute pancreatitis.
abstract: OBJECTIVE
  Intra-abdominal fungal infections (AFIs) complicating acute pancreatitis arise in the context of pancreatic necrosis. Our goal was to determine which risk factors contribute to AFI in patients with acute pancreatitis.
  
  
  METHODS
  Records were reviewed from 479 nontransfer patients admitted to our medical center with acute pancreatitis from 1985 to 2009. Using multivariable regression models, we identified risk factors for AFI.
  
  
  RESULTS
  Of 479 patients admitted with acute pancreatitis, 17 patients were subsequently found to have an AFI and 3 of these patients died. The mean length of stay for patients with an AFI was 24 days, and 76% were admitted to the intensive care unit. The patients with AFI were more likely to have received prophylactic antibiotics on admission (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2-2.3) and total parenteral nutrition within 7 days of admission (OR, 1.4; 95% CI, 1.1-1.7) or to have necrosis on CT scan within 7 days of admission (OR, 1.4; 95% CI, 1.1-1.7). Multivariable regression models identified admission antibiotic use (OR, 1.6; 95% CI, 1.4-1.8) as the strongest predictor of AFI.
  
  
  CONCLUSIONS
  Admission antibiotics are the biggest risk factor for the development of intra-AFIs in acute pancreatitis. Prophylactic antibiotics to prevent infected necrosis should therefore be discouraged.
authors: From the *Department of Gastroenterology and Hepatology, Norwalk Hospital, Norwalk, CT; and †Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Brian J
authors: BJ
authors: Schwender
authors: Stuart R
authors: SR
authors: Gordon
authors: Timothy B
authors: TB
authors: Gardner
mesh_terms: D000046:Academic Medical Centers; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009181:Mycoses / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D009513:New Hampshire; D016017:Odds Ratio; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D010289:Parenteral Nutrition, Total; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents