Fungal Infections in Patients with Walled-off Pancreatic Necrosis

Mikkel Werge; Stine Roug; Srdan Novovic; Palle Nordblad Schmidt; Erik Feldager Hansen; Jenny Dahl Knudsen

doi:10.1097/MPA.0000000000000675

Fungal Infections in Patients with Walled-off Pancreatic Necrosis

Mikkel Werge^*, Stine Roug, Srdan Novovic, Palle Nordblad Schmidt, Erik Feldager Hansen, Jenny Dahl Knudsen

^*Corresponding author for this work

7 Citations (Scopus)

Abstract

Objectives This study aimed to evaluate the influence of fungal infection and antifungal treatment on outcome in patients with walled-off pancreatic necrosis (WON). Methods A retrospective description of fungal infections in a cohort of consecutive patients undergoing endoscopic, transmural drainage and necrosectomy for WON, treated in a tertiary referral center was reviewed. Results Between 2005 and 2013, fungal infection in WON was documented in 57 (46%) of 123 patients. The most common isolates at first positive culture were Candida albicans (55%) and Candida glabrata (20%). Thirty-nine (70%) patients were treated with antifungals after the first fungal finding. There was no significant difference in mortality (21% vs 13%, P = 0.517) or organ failure (34% vs 33%, P = 0.903) between the group treated with adequate antifungals after the first fungal finding compared to the group not treated or treated inadequately. The in-hospital mortality was 18% (10 patients). Concomitant fungemia was found in 6 patients, of which 3 died, as opposed to 7 with fungi in the necrosis only (50% vs 14%, P = 0.027). Conclusions This study demonstrates a high incidence and associated high in-hospital mortality of fungal infection in WON, thus emphasizing the importance of fungal infections in WON.

Original language	English
Journal	Pancreas
Volume	45
Issue number	10
Pages (from-to)	1447-1451
Number of pages	5
ISSN	0885-3177
DOIs	https://doi.org/10.1097/MPA.0000000000000675
Publication status	Published - 2016

Keywords

antifungal treatment
candida
mortality
necrotizing pancreatitis

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title = "Fungal Infections in Patients with Walled-off Pancreatic Necrosis",

abstract = "Objectives This study aimed to evaluate the influence of fungal infection and antifungal treatment on outcome in patients with walled-off pancreatic necrosis (WON). Methods A retrospective description of fungal infections in a cohort of consecutive patients undergoing endoscopic, transmural drainage and necrosectomy for WON, treated in a tertiary referral center was reviewed. Results Between 2005 and 2013, fungal infection in WON was documented in 57 (46%) of 123 patients. The most common isolates at first positive culture were Candida albicans (55%) and Candida glabrata (20%). Thirty-nine (70%) patients were treated with antifungals after the first fungal finding. There was no significant difference in mortality (21% vs 13%, P = 0.517) or organ failure (34% vs 33%, P = 0.903) between the group treated with adequate antifungals after the first fungal finding compared to the group not treated or treated inadequately. The in-hospital mortality was 18% (10 patients). Concomitant fungemia was found in 6 patients, of which 3 died, as opposed to 7 with fungi in the necrosis only (50% vs 14%, P = 0.027). Conclusions This study demonstrates a high incidence and associated high in-hospital mortality of fungal infection in WON, thus emphasizing the importance of fungal infections in WON.",

keywords = "antifungal treatment, candida, mortality, necrotizing pancreatitis",

author = "Mikkel Werge and Stine Roug and Srdan Novovic and Schmidt, {Palle Nordblad} and Hansen, {Erik Feldager} and Knudsen, {Jenny Dahl}",

year = "2016",

doi = "10.1097/MPA.0000000000000675",

language = "English",

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pages = "1447--1451",

journal = "Pancreas",

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TY - JOUR

T1 - Fungal Infections in Patients with Walled-off Pancreatic Necrosis

AU - Werge, Mikkel

AU - Roug, Stine

AU - Novovic, Srdan

AU - Schmidt, Palle Nordblad

AU - Hansen, Erik Feldager

AU - Knudsen, Jenny Dahl

PY - 2016

Y1 - 2016

N2 - Objectives This study aimed to evaluate the influence of fungal infection and antifungal treatment on outcome in patients with walled-off pancreatic necrosis (WON). Methods A retrospective description of fungal infections in a cohort of consecutive patients undergoing endoscopic, transmural drainage and necrosectomy for WON, treated in a tertiary referral center was reviewed. Results Between 2005 and 2013, fungal infection in WON was documented in 57 (46%) of 123 patients. The most common isolates at first positive culture were Candida albicans (55%) and Candida glabrata (20%). Thirty-nine (70%) patients were treated with antifungals after the first fungal finding. There was no significant difference in mortality (21% vs 13%, P = 0.517) or organ failure (34% vs 33%, P = 0.903) between the group treated with adequate antifungals after the first fungal finding compared to the group not treated or treated inadequately. The in-hospital mortality was 18% (10 patients). Concomitant fungemia was found in 6 patients, of which 3 died, as opposed to 7 with fungi in the necrosis only (50% vs 14%, P = 0.027). Conclusions This study demonstrates a high incidence and associated high in-hospital mortality of fungal infection in WON, thus emphasizing the importance of fungal infections in WON.

AB - Objectives This study aimed to evaluate the influence of fungal infection and antifungal treatment on outcome in patients with walled-off pancreatic necrosis (WON). Methods A retrospective description of fungal infections in a cohort of consecutive patients undergoing endoscopic, transmural drainage and necrosectomy for WON, treated in a tertiary referral center was reviewed. Results Between 2005 and 2013, fungal infection in WON was documented in 57 (46%) of 123 patients. The most common isolates at first positive culture were Candida albicans (55%) and Candida glabrata (20%). Thirty-nine (70%) patients were treated with antifungals after the first fungal finding. There was no significant difference in mortality (21% vs 13%, P = 0.517) or organ failure (34% vs 33%, P = 0.903) between the group treated with adequate antifungals after the first fungal finding compared to the group not treated or treated inadequately. The in-hospital mortality was 18% (10 patients). Concomitant fungemia was found in 6 patients, of which 3 died, as opposed to 7 with fungi in the necrosis only (50% vs 14%, P = 0.027). Conclusions This study demonstrates a high incidence and associated high in-hospital mortality of fungal infection in WON, thus emphasizing the importance of fungal infections in WON.

KW - antifungal treatment

KW - candida

KW - mortality

KW - necrotizing pancreatitis

U2 - 10.1097/MPA.0000000000000675

DO - 10.1097/MPA.0000000000000675

M3 - Journal article

C2 - 27518465

AN - SCOPUS:84981736908

SN - 0885-3177

VL - 45

SP - 1447

EP - 1451

JO - Pancreas

JF - Pancreas

IS - 10

ER -

Fungal Infections in Patients with Walled-off Pancreatic Necrosis

Abstract

Keywords

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