Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY.
J Clin Gastroenterol. 2021 Mar 1;55(3):218-226. doi: 10.1097/MCG.0000000000001467.
The goal of this study was to study the incidence of fungal infection in necrotizing pancreatitis (NP) and its impact on mortality.
Infected pancreatic necrosis is a major contributor to morbidity and mortality in patients with NP. While pancreatic fungal infection (PFI) has frequently been identified in patients with NP, its effect on the clinical outcomes is unclear.
A literature search was performed in Medline (Ovid), Embase (Ovid), and the Cochrane library. All prospective and retrospective studies that examined the incidence of fungal infection in NP with subgroup mortality data were included. For fungal infection of NP, studies with fungal isolation from pancreatic necrotic tissue were included. Newcastle Ottawa Scale and Joanna Briggs Institute's critical appraisal tool were used for bias assessment.
Twenty-two studies comprising 2151 subjects with NP were included for the quantitative analysis. The mean incidence of fungal infection was 26.6% (572/2151). In-hospital mortality in the pooled sample of NP patients with PFI (N=572) was significantly higher [odds ratio (OR)=3.95, 95% confidence interval (CI): 2.6-5.8] than those without PFI. In a separate analysis of 7 studies, the mean difference in the length of stay between those with and without fungal infection was 22.99 days (95% CI: 14.67-31.3). The rate of intensive care unit admission (OR=3.95; 95% CI: 2.6-5.8), use of prophylactic antibacterials (OR=2.76; 95% CI: 1.31-5.81) and duration of antibacterial therapy (mean difference=8.71 d; 95% CI: 1.33-16.09) were all significantly higher in patients with PFI. Moderate heterogeneity was identified among the studies on estimating OR for mortality (I2=43%) between the 2 groups.
PFI is common in patients with NP and is associated with increased mortality, intensive care unit admission rate, and length of stay. Further prospective studies are needed to better understand the pathophysiology of PFIs and to determine the role for preemptive therapeutic strategies, such as prophylactic antifungal therapy.
本研究旨在研究坏死性胰腺炎（NP）中真菌感染的发生率及其对死亡率的影响。
感染性胰腺坏死是 NP 患者发病率和死亡率的主要原因。虽然 NP 患者常发生胰腺真菌感染（PFI），但其对临床结局的影响尚不清楚。
在 Medline（Ovid）、Embase（Ovid）和 Cochrane 图书馆中进行文献检索。纳入了所有检查 NP 真菌感染发生率并具有亚组死亡率数据的前瞻性和回顾性研究。对于 NP 的真菌感染，纳入了从胰腺坏死组织中分离真菌的研究。采用纽卡斯尔-渥太华量表和 Joanna Briggs 研究所的批判性评估工具进行偏倚评估。
共纳入 22 项研究，共 2151 例 NP 患者进行定量分析。真菌感染的平均发生率为 26.6%（572/2151）。在合并有 PFI 的 NP 患者（N=572）的住院期间死亡率明显更高[比值比（OR）=3.95，95%置信区间（CI）：2.6-5.8]。在单独对 7 项研究的分析中，有和无真菌感染的患者之间的平均住院时间差异为 22.99 天（95%CI：14.67-31.3）。入住重症监护病房的比例（OR=3.95；95%CI：2.6-5.8）、预防性使用抗菌药物的比例（OR=2.76；95%CI：1.31-5.81）和抗菌治疗持续时间（平均差异=8.71d；95%CI：1.33-16.09）均显著更高。在估计死亡率的 OR 方面，两组之间的研究存在中度异质性（I2=43%）。
PFI 在 NP 患者中很常见，与死亡率增加、入住重症监护病房的比例和住院时间延长有关。需要进一步的前瞻性研究来更好地了解 PFIs 的病理生理学，并确定预防性治疗策略（如预防性抗真菌治疗）的作用。
