Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA.
Med Mycol. 2023 Jul 6;61(7). doi: 10.1093/mmy/myad068.
Pancreatic fungal infection (PFI) in patients with necrotizing pancreatitis can lead to significant morbidity and mortality. The incidence of PFI has increased during the past decade. Our study aimed to provide contemporary observations on the clinical characteristics and outcomes of PFI in comparison to pancreatic bacterial infection and necrotizing pancreatitis without infection. We conducted a retrospective study of patients with necrotizing pancreatitis (acute necrotic collection or walled-off necrosis), who underwent pancreatic intervention (necrosectomy and/or drainage) and had tissue/fluid culture between 2005 and 2021. We excluded patients with pancreatic procedures prior to hospitalization. Multivariable logistic and Cox regression models were fitted for in-hospital and 1-year survival outcomes. A total of 225 patients with necrotizing pancreatitis were included. Pancreatic fluid and/or tissue was obtained from endoscopic necrosectomy and/or drainage (76.0%), CT-guided percutaneous aspiration (20.9%), or surgical necrosectomy (3.1%). Nearly half of the patients had PFI with or without concomitant bacterial infection (48.0%), while the remaining patients had either bacterial infection alone (31.1%) or no infection (20.9%). In multivariable analysis to assess the risk of PFI or bacterial infection alone, only previous pancreatitis was associated with an increased odds of PFI vs. no infection (OR 4.07, 95% CI 1.13-14.69, p = .032). Multivariable regression analyses revealed no significant differences in in-hospital outcomes or one-year survival between the 3 groups. Pancreatic fungal infection occurred in nearly half of necrotizing pancreatitis. Contrary to many of the previous reports, there was no significant difference in important clinical outcomes between the PFI group and each of the other two groups.
胰腺真菌性感染（PFI）在坏死性胰腺炎患者中可导致显著的发病率和死亡率。在过去十年中，PFI 的发病率有所增加。我们的研究旨在提供关于 PFI 的临床特征和结局的当代观察结果，与胰腺细菌性感染和无感染的坏死性胰腺炎进行比较。我们对 2005 年至 2021 年间接受胰腺介入（坏死切除术和/或引流术）且组织/液体培养阳性的坏死性胰腺炎患者进行了回顾性研究。我们排除了在住院前进行胰腺手术的患者。使用多变量逻辑和 Cox 回归模型评估住院期间和 1 年的生存结果。共纳入 225 例坏死性胰腺炎患者。胰腺液体和/或组织取自内镜坏死切除术和/或引流术（76.0%）、CT 引导下经皮抽吸术（20.9%）或手术坏死切除术（3.1%）。近一半的患者存在 PFI 合并或不合并细菌感染（48.0%），而其余患者仅存在细菌感染（31.1%）或无感染（20.9%）。在多变量分析中评估 PFI 或单独细菌感染的风险时，只有既往胰腺炎与 PFI 与无感染相比，发生感染的几率增加（比值比 4.07，95%置信区间 1.13-14.69，p =.032）。多变量回归分析显示，3 组之间的住院期间结局或 1 年生存率无显著差异。在坏死性胰腺炎中，近一半发生了胰腺真菌性感染。与许多之前的报告相反，PFI 组与其他两组之间在重要的临床结局方面没有显著差异。
