Impact of invasive infections on clinical outcomes in acute pancreatitis: early predictive factors and implications for prophylactic anti-infective therapy
Abstract Background The use of antibiotic therapy in acute pancreatitis remains controversial and is currently recommended only for confirmed infections of peripancreatic necrosis. However, reliable early predictors of septic complications and unfavorable outcomes are substantially lacking. Methods...
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2025-01-01
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| Series: | Gut Pathogens |
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| Online Access: | https://doi.org/10.1186/s13099-024-00671-3 |
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| author | Fabienne Bender Theresa König Matthias Hecker Moritz Fritzenwanker Jacqueline Braun Joern Pons-Kühnemann Matthias Wolff Andreas Hecker Martin Reichert |
| author_facet | Fabienne Bender Theresa König Matthias Hecker Moritz Fritzenwanker Jacqueline Braun Joern Pons-Kühnemann Matthias Wolff Andreas Hecker Martin Reichert |
| author_sort | Fabienne Bender |
| collection | DOAJ |
| description | Abstract Background The use of antibiotic therapy in acute pancreatitis remains controversial and is currently recommended only for confirmed infections of peripancreatic necrosis. However, reliable early predictors of septic complications and unfavorable outcomes are substantially lacking. Methods Patients with acute pancreatitis were retrospectively reviewed and divided into two groups: one with a septic course defined by pathogen detection [GERM(+)] and one without [GERM(-)]. After propensity score matching, both groups were compared regarding clinical outcomes. Early predictors of pathogen detection were evaluated by multivariate analysis. Results 424 patients with acute pancreatitis were included. After propensity score matching 123 GERM(-) patients were compared to 74 GERM(+) patients. GERM(+) patients demonstrated significantly worse clinical outcomes with higher rate of intensive care treatment (59.5% vs. 35.0%; p = 0.0011) and consecutive longer stay in intensive care unit (11.5 ± 25.2d vs. 3.0 ± 7.9d; p = 0.0007), longer in-hospital stay (26.8 ± 22.0d vs. 14.7 ± 15.0d; p = 0.0003) as well as worse results in the composite outcome length of in-hospital stay > 15d or death (67.6% vs. 31.7%; p < 0.0001). Prescence of ascites and elevated white blood cell count at the onset of acute pancreatitis were identified as significant predictive factors in the early disease associated with invasive infection and pathogen detection. The most frequently detected pathogens were commensals of the gastrointestinal tract, observed in 70.7% of the examined body fluids and 50.7% of the examined blood cultures. Conclusions Detection of pathogens is associated with unfavorable clinical outcomes in acute pancreatitis. The presence of ascites and elevated white blood cell count at onset of acute pancreatitis are significant predictive factors indicating the risk of invasive infection with relevant bacterial load. Thus, an aggressive, early anti-infective strategy against pathogens of intestinal origin should be considered in these cases and may improve patient outcomes. |
| format | Article |
| id | doaj-art-4a51f9ff88bd4e87bfda21bc6960c204 |
| institution | Kabale University |
| issn | 1757-4749 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | Gut Pathogens |
| spelling | doaj-art-4a51f9ff88bd4e87bfda21bc6960c2042025-01-19T12:25:17ZengBMCGut Pathogens1757-47492025-01-0117111310.1186/s13099-024-00671-3Impact of invasive infections on clinical outcomes in acute pancreatitis: early predictive factors and implications for prophylactic anti-infective therapyFabienne Bender0Theresa König1Matthias Hecker2Moritz Fritzenwanker3Jacqueline Braun4Joern Pons-Kühnemann5Matthias Wolff6Andreas Hecker7Martin Reichert8Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital of GiessenDepartment of General, Visceral, Thoracic and Transplant Surgery, University Hospital of GiessenDepartment of Pulmonary and Critical Care Medicine, University Hospital of GiessenInstitute of Medical Microbiology, Justus-Liebig-University of GiessenDepartment of General, Visceral, Thoracic and Transplant Surgery, University Hospital of GiessenMedical Statistics, Institute of Medical Informatics, Justus-Liebig-University of GiessenDepartment of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of GiessenDepartment of General, Visceral, Thoracic and Transplant Surgery, University Hospital of GiessenDepartment of General, Visceral, Thoracic and Transplant Surgery, University Hospital of GiessenAbstract Background The use of antibiotic therapy in acute pancreatitis remains controversial and is currently recommended only for confirmed infections of peripancreatic necrosis. However, reliable early predictors of septic complications and unfavorable outcomes are substantially lacking. Methods Patients with acute pancreatitis were retrospectively reviewed and divided into two groups: one with a septic course defined by pathogen detection [GERM(+)] and one without [GERM(-)]. After propensity score matching, both groups were compared regarding clinical outcomes. Early predictors of pathogen detection were evaluated by multivariate analysis. Results 424 patients with acute pancreatitis were included. After propensity score matching 123 GERM(-) patients were compared to 74 GERM(+) patients. GERM(+) patients demonstrated significantly worse clinical outcomes with higher rate of intensive care treatment (59.5% vs. 35.0%; p = 0.0011) and consecutive longer stay in intensive care unit (11.5 ± 25.2d vs. 3.0 ± 7.9d; p = 0.0007), longer in-hospital stay (26.8 ± 22.0d vs. 14.7 ± 15.0d; p = 0.0003) as well as worse results in the composite outcome length of in-hospital stay > 15d or death (67.6% vs. 31.7%; p < 0.0001). Prescence of ascites and elevated white blood cell count at the onset of acute pancreatitis were identified as significant predictive factors in the early disease associated with invasive infection and pathogen detection. The most frequently detected pathogens were commensals of the gastrointestinal tract, observed in 70.7% of the examined body fluids and 50.7% of the examined blood cultures. Conclusions Detection of pathogens is associated with unfavorable clinical outcomes in acute pancreatitis. The presence of ascites and elevated white blood cell count at onset of acute pancreatitis are significant predictive factors indicating the risk of invasive infection with relevant bacterial load. Thus, an aggressive, early anti-infective strategy against pathogens of intestinal origin should be considered in these cases and may improve patient outcomes.https://doi.org/10.1186/s13099-024-00671-3Acute pancreatitisPathogensAntibiotic prophylaxisAscitesWhite blood cell count |
| spellingShingle | Fabienne Bender Theresa König Matthias Hecker Moritz Fritzenwanker Jacqueline Braun Joern Pons-Kühnemann Matthias Wolff Andreas Hecker Martin Reichert Impact of invasive infections on clinical outcomes in acute pancreatitis: early predictive factors and implications for prophylactic anti-infective therapy Gut Pathogens Acute pancreatitis Pathogens Antibiotic prophylaxis Ascites White blood cell count |
| title | Impact of invasive infections on clinical outcomes in acute pancreatitis: early predictive factors and implications for prophylactic anti-infective therapy |
| title_full | Impact of invasive infections on clinical outcomes in acute pancreatitis: early predictive factors and implications for prophylactic anti-infective therapy |
| title_fullStr | Impact of invasive infections on clinical outcomes in acute pancreatitis: early predictive factors and implications for prophylactic anti-infective therapy |
| title_full_unstemmed | Impact of invasive infections on clinical outcomes in acute pancreatitis: early predictive factors and implications for prophylactic anti-infective therapy |
| title_short | Impact of invasive infections on clinical outcomes in acute pancreatitis: early predictive factors and implications for prophylactic anti-infective therapy |
| title_sort | impact of invasive infections on clinical outcomes in acute pancreatitis early predictive factors and implications for prophylactic anti infective therapy |
| topic | Acute pancreatitis Pathogens Antibiotic prophylaxis Ascites White blood cell count |
| url | https://doi.org/10.1186/s13099-024-00671-3 |
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