[Impact of secondary pancreatic infection on the prognosis of patients with severe acute pancreatitis: an analysis of 60 cases].

OBJECTIVE

To investigate the impact of secondary pancreatic infection (SPI) on the prognosis of patients with severe acute pancreatitis (SAP).

METHODS

Clinical data of 60 patients with SAP (January 1, 1980-December 31, 1999), especially the data at the onset of SPI, were retrospectively analyzed.

RESULTS

Sixty patients were divided into two groups: SPI group (29 cases) and non-SPI group (31 cases). There was no significant difference in gender, average age, scores of Ranson and of high risk factors of China Medical Association between two groups, but the average stay days in hospital, payment, acute physiology and chronic health evaluation II (APACHE II) scores, days of fever, prehospital days, days of high white blood cell (WBC) count, the duration of constipation after the onset of SAP and average times of operation were significantly higher in SPI group than that of non-SPI group. Fatality rate of SPI group (7/29, 24.14 percent) was higher than that of non-SPI (1/31, 3.23 percent). There were 14 cases of infection with single microorganism (48.3 percent) and 15 cases of mixed infection (51.7 percent) in SPI group. Twenty-seven patients were infected with bacteria of Enterobacteriaecae (Escherichia 25, Klebsiella pneumoniae 1, Proteus morgani 1, 8 with bacteria of Pseudomonas (P. aeruginosa 7, P. stanieri 1), 2 with fungus, 5 with other bacteria (Bacillus subtilis 2, Tetracoccus 1, Acetobacteraceae 1, Staphylococcus epidermidis 1) in SPI group. Only in 2 patients with infective pancreatic necrosis the blood culture was positive (Escherichia coli).

CONCLUSION

These results showed that the major source of SPI is entergenous, and SPI would affect the prognosis of SAP patients. With the present therapeutic regimes it was hard to prevent entergenous infections. It is necessary to find a new strategy.