Candida infection of local necrosis in severe acute pancreatitis is associated with increased mortality

The aim of this study was to evaluate the frequency of Candida infection of pancreatic necrosis in patients suffering from severe acute pancreatitis ( SAP) and to analyze its impact on the outcome. Two-hundred and fifty consec utive patients with SAP from January 1986 to December 1998 were studied ret rospectively. Their mean APACHE II score at the day of admission was in 16. 1 (range 8-35). All patients were in need of operative therapy. Overall mor tality was 38.8% (97 patients), One-hundred and eighty-two patients (72.8%) suffered from local infected necrosis. Among these patients, local Candida infection was observed in 31 patients, whereof 23 patients (74%) suffered from local fungal infection detected at first operation. During the course of disease, 12 patients (39%) also revealed fungemia. Local Candida infecti on as compared to no Candida infection was associated with an increased mor tality rate (84% vs. 32%; P < 0.0001). Multivariate logistic regression ana lysis identified APACHE II score (P < 0.0001), age of the patient (P < 0.00 3), extent of pancreatic necrosis (P < 0.002), and local bacterial (P < 0.0 4) and fungal infection (P < 0.004) as independent factors significantly co ntributing to mortality. SAP, requiring surgical treatment, is associated w ith high in-hospital mortality. Patients suffering from local Candida infec tion are at high risk of fatal outcome.