CT-GUIDED ASPIRATION OF SUSPECTED PANCREATIC INFECTION - BACTERIOLOGYAND CLINICAL OUTCOME

We have performed CT-guided percutaneous needle aspiration in 104 pati ents with severe pancreatitis strongly suspected of harboring pancreat ic infection on the basis of systemic toxicity and CT findings (Baltha zar CT grade D or E). Of these 104 patients, 51 (49%) were documented with pancreatic infection. Gram stain was positive in 54 of 58 infecte d aspirates, and culture was positive in all 58. Klebsiella, Escherich ia coli, and Staphylococcus aureus were the most frequent organisms. E ighty-six percent of infected processes contained only one organism. O verall, pancreatic infection was documented by GPA within the first 2 wk in approx one-half of patients, There were no complications. The ov erall rate of infection decreased from 60 (1980-1987) to 34% (1988-199 5) (p = 0.011). This change was caused by a reduction in the rate of i nfected necrosis from 67 to 32% (p = 0.015). The overall mortality rat e remained at 20%. The mortality of sterile pancreatitis was not diffe rent from infected pancreatitis (p = 0.14). We conclude that GPA is a safe, accurate method of diagnosis of pancreatic infection. The rate o f pancreatic infection appears to be decreasing. The overall mortality of severe pancreatitis among patients suspected of harboring pancreat ic infection has remained unchanged because of the high mortality asso ciated with both infected necrosis and severe sterile necrosis.