Fungal infections in patients with severe acute pancreatitis and the use of prophylactic therapy

Introduction

Infection of pancreatic necrosis is associated with an increased mortality rate in patients with severe acute pancreatitis. It is not clear whether fungal involvement in pancreatic infection further increases the odds for mortality.

Objective

To analyze the incidence of fungal infection in patients with infected pancreatic necrosis, to identify risk factors for development of fungal infection and to assess the use of early fluconazole treatment.

Patients and methods

We retrospectively (1995–2002) analyzed 46 consecutive patients with infected pancreatic necrosis from a total of 106 patients that were admitted to the ICU because of severe acute pancreatitis. We recorded demographic characteristics, incidence of organ failure, data on antimicrobial and antifungal treatment, and disease severity.

Results

Intra-abdominal fungal infection was found in 17 of 46 patients (37%). Primary infection was present in eight patients, in nine others fungal infection occurred later in the course of the disease. Candida albicans was isolated most frequently (15/17); C. tropicalis and C. Krusei were found in one patient each. Characteristics (age, gender, APACHE II score, Ranson score, the use and duration of prophylactic antibiotics) of patients with fungal infections were not different from patients without fungal infection. Mortality was statistically not significantly different in patients with fungal infections (35% vs 27% in the other patients, P = 0.58). Antifungal prophylaxis or pre-emptive antifungal therapy was used in 19 patients, and only three of them developed fungal infection: there was one breakthrough infection with C. Krusei, and two patients developed C. albicans infections later in the course of the disease, after antifungal treatment had been stopped for 3 and 4 weeks, respectively.

Conclusion

The incidence of fungal infections in patients with infected pancreatic necrosis is high. In this cohort of critically ill patients, no risk factors for fungal infection could be demonstrated, and mortality was not different. Early treatment with fluconazole seems to prevent fungal infections in these high-risk patients.