Intra-abdominal Candida infection during acute necrotizing pancreatitis has a high prevalence and is associated with increased mortality.

OBJECTIVES

To analyze the frequency of intra-abdominal Candida infection during acute necrotizing pancreatitis and to compare the outcome to patients without Candida infections.

DESIGN

Retrospective analysis of data from 37 patients with and without Candida infection.

SETTING

Surgical intensive care unit (ICU) in a university hospital.

PATIENTS

Thirty-seven patients with acute necrotizing pancreatitis.

INTERVENTIONS

Patients were subject to necrosectomy and programmed lavage.

MEASUREMENTS AND MAIN RESULTS

Clinical parameters contained in the Acute Physiology and Chronic Health Evaluation (APACHE) II score were monitored, as were microbiological results from the intra-abdominal primary focus and from sites of secondary infections. Body mass index, distribution of underlying diseases, length of ICU stay, number of operations, and outcome were recorded. Multivariate logistic regression analysis for mortality as the dependent variable was performed. Intra-abdominal Candida infection was observed in 13 of 37 cases and was associated with a four-fold greater mortality rate compared with intra-abdominal bacterial infection alone. Multivariate logistic regression analysis demonstrated that Candida infection contributed to mortality significantly (p < .025) and independently from APACHE II (p < .006; mortality odds ratio for the two parameters=12.5). Lack of antimycotic treatment was associated with an increase to 29.2 (p<.001) in the odds ratio.

CONCLUSIONS

Given the impact of Candida infection on mortality to acute necrotizing pancreatitis and the apparent benefit from antimycotic chemotherapy, the data argue for an early fungicide chemotherapeutic intervention.