1. Timing and impact of infections in acute pancreatitis
- Author
-
Besselink, M.G., van Santvoort, H.C., Boermeester, M.A., Nieuwenhuijs, V.B., van Goor, H., Dejong, C.H., Cuesta valentin, M.A., Mulder, C.J.J., Schaapherder, A.F., Gooszen, H.G., Surgery, Gastroenterology and hepatology, Other Research, Other departments, AII - Amsterdam institute for Infection and Immunity, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Algemene Heelkunde, RS: NUTRIM - R2 - Gut-liver homeostasis, and Faculteit Medische Wetenschappen/UMCG
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pancreatic disease ,Age-related aspects of cancer [ONCOL 2] ,Time Factors ,Bacteremia ,NEEDLE-ASPIRATION HELPFUL ,CONTROLLED-TRIAL ,Gastroenterology ,DOUBLE-BLIND ,ACUTE NECROTIZING PANCREATITIS ,Enteral Nutrition ,Interquartile range ,Internal medicine ,medicine ,Pneumonia, Bacterial ,Humans ,Molecular gastro-enterology and hepatology [IGMD 2] ,Gram-Positive Bacterial Infections ,Cause of death ,Aged ,COMPLICATIONS ,business.industry ,Pancreatitis, Acute Necrotizing ,MORTALITY ,NECROSIS ,Odds ratio ,Middle Aged ,medicine.disease ,bacterial infections and mycoses ,Prognosis ,Surgery ,Anti-Bacterial Agents ,Pneumonia ,Mycoses ,Pancreatitis ,Evaluation of complex medical interventions [NCEBP 2] ,Acute Disease ,Acute pancreatitis ,ANTIBIOTIC-TREATMENT ,Female ,business ,ORGAN FAILURE ,Gram-Negative Bacterial Infections - Abstract
Background Although infected necrosis is an established cause of death in acute pancreatitis, the impact of bacteraemia and pneumonia is less certain. Methods This was a cohort study of 731 patients with a primary episode of acute pancreatitis in 2004–2007, including 296 patients involved in a randomized controlled trial to investigate the value of probiotic treatment in severe pancreatitis. Time of onset of bacteraemia, pneumonia, infected pancreatic necrosis, persistent organ failure and death were recorded. Results The initial infection in 173 patients was diagnosed a median of 8 (interquartile range 3–20) days after admission (infected necrosis, median day 26; bacteraemia/pneumonia, median day 7). Eighty per cent of 61 patients who died had an infection. In 154 patients with pancreatic parenchymal necrosis, bacteraemia was associated with increased risk of infected necrosis (65 versus 37·9 per cent; P = 0·002). In 98 patients with infected necrosis, bacteraemia was associated with higher mortality (40 versus 16 per cent; P = 0·014). In multivariable analysis, persistent organ failure (odds ratio (OR) 18·0), bacteraemia (OR 3·4) and age (OR 1·1) were associated with death. Conclusion Infections occur early in acute pancreatitis, and have a significant impact on mortality, especially bacteraemia. Prophylactic strategies should focus on early intervention.
- Published
- 2009
- Full Text
- View/download PDF