Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2019; 25(34): 5162-5173
Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5162
Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis
Jiong-Di Lu, Feng Cao, Yi-Xuan Ding, Yu-Duo Wu, Yu-Lin Guo, Fei Li
Jiong-Di Lu, Feng Cao, Yi-Xuan Ding, Yu-Lin Guo, Fei Li, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Yu-Duo Wu, Department of Cardiac Surgery, Beijing Anzhen Hospital Affiliated to Capital University of Medical Sciences, Beijing 100029, China
Author contributions: Lu JD is the first author; Cao F and Li F designed and performed the research; Ding YX, Guo YL, and Wu YD contributed the analytical tools; Lu JD, Ding YX, and Guo YL analyzed the data; Lu JD wrote the manuscript; Cao F, Ding YX, and Li F revised the manuscript; and all authors read and approved the final manuscript.
Supported by the Beijing Municipal Science & Technology Commission, No. Z171100001017077; the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support, No. XMLX201404.
Institutional review board statement: The study was reviewed and approved by the Xuanwu Hospital Institutional Review Board.
Informed consent statement: The data of our study cohort was obtained retrospectively from the Xuanwu Hospital Database of Capital Medical University. Hence informed consent statement is unnecessary.
Conflict-of-interest statement: None of the authors has a conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Fei Li, MD, PhD, Chief Doctor, Professor, Surgeon, Department of General Surgery, Xuanwu Hospital of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China.
Telephone: +86-10-83198731 Fax: +86-10-83198868
Received: June 26, 2019
Peer-review started: June 26, 2019
First decision: July 20, 2019
Revised: August 7, 2019
Accepted: August 19, 2019
Article in press: August 19, 2019
Published online: September 14, 2019
Research background

As acute pancreatitis patients progress to necrotizing pancreatitis (NP), their hospitalization costs and mortality rates become much higher than those of patients with edematous pancreatitis. Approximately 40%-70% of NP cases present with symptoms of infection, and infection has become the most important risk factor for death from NP. Therefore, it is critical to identify patients with NP who have symptoms of infection.

Research motivation

Studies on pancreatic infectious have mainly focused on pancreatic and peripancreatic infections, and little is known about extrapancreatic infections and coinfections. We considered the difference in infection time, infection site, and infectious strains in NP patients with infectious complications, and found that early intervention may decrease the mortality rate.

Research objectives

Infectious NP, extrapancreatic infection, and coinfection are the common complications of NP. The research is critical to improve the treatment strategy for NP patients with infectious complications.

Research methods

This study included 205 patients with NP. The baseline data were recorded as the mean ± SD or medians (ranges) as appropriate. Independent samples t-tests were performed to analyze the differences between the groups. Qualitative data were scored, and chi-square or Fisher’s exact tests were performed to analyze the differences between the groups. Logistic regression was used to determine the risk of death in the patients using via SPSS 23.0 statistical software.

Research results

A total of 539 strains of pathogenic bacteria were cultured from the 162 NP patients with confirmed infectious complications. The most common Gram-negative bacteria were P. aeruginosa and E. coli (n = 34). The most common Gram-positive bacteria were E. faecium (n = 18), and the most common fungus was C. albicans (n = 3). The extrapancreatic infection time was 9.1 ± 8.8 d, the pancreatic infection time was 13.9 ± 12.3 d, and the fungal infection time was 31.6 ± 26.4 d (P < 0.05). The common sites of extrapancreatic infection in patients with advanced NP (> 14 d) were the blood, respiratory tract, and urinary tract.

Research conclusions

This retrospective analysis of NP patients with infectious com-plications in our hospital shows that the main pathogenic bacteria in NP patients were Gram-negative bacteria, the most common of which were E. coli and P. aeruginosa. Additionally, it was found that the proportion of multidrug-resistant bacteria was relatively large, and caution should be used in the application of antibiotics. The extrapancreatic infection time was usually earlier than the pancreatic infection time. For patients with suspected extrapancreatic infection, blood and respiratory pathogen culture should be prioritized. Third- or fourth-generation cephalosporins or carbapenems can be used as empirical antibiotics. Persistent organ failure, multidrug resistance, and surgery were risk factors for death.

Research perspectives

We confirmed the common infectious strains, the site of infection, and the time of infection in NP patients with infectious complications. Through these results, we found that it is helpful for clinicians to evaluate the patient's condition in a timely manner to improve the patient's prognosis.