Fungal infection in acute necrotizing pancreatitis

Background: Anecdotal reports suggest that patients with fungal infection o f necrotizing pancreatitis (NP) have worse outcomes than those with bacteri al infection. Our aim was to compare the clinical course and outcomes of pa tients with NP infected with fungal versus nonfungal organisms. Study Design: Prospectively collected data on 57 patients with infected NP (1983-1995) were reviewed. Results: Seven patients (12%) developed fungal infection, and 50 (88%) deve loped bacterial infection. Groups had similar mean ages (60 versus 63 years ) and APACHE-II scores on admission (9 each). The cause of NP was ERCP-indu ced in 3 of 7 with fungal infection versus 3 of 50 with bacterial infection . Patients with fungal infection had been treated with a mean of 4 differen t antibiotics for a mean of 23 days, and 4 of 7 (57%) required mechanical v entilation preoperatively. In addition, postoperative ICU stays were longer (20 versus 10 days), as were total hospital stays (59 versus 41 days). Mor tality was higher with fungal infection; 3 of 7 patients (43%) died versus 10 of 50 patients (20%). Conclusions: Although NP presents with similar initial severity, patients w ith fungal infection of NP tend to have a more complicated course and worse outcomes compared with those with bacterial infection. Low-dose antifungal prophylaxis should be added to early management of NP. (J Am Coil Surg 199 9;188:408-414. (C) 1999 by the American College of Surgeons).