Ritu Singh, MD1, Yakira David, MBBS2, Antonio R. Cheesman, MD3, Rebekah E. Dixon, BS4, Satish Nagula, MD2, Christopher J. DiMaio, MD2, David A. Greenwald, MD, FACG5, Nikhil Kumta, MD, MS5; 1Parkview Health, Fort Wayne, IN; 2Icahn School of Medicine at Mount Sinai, New York, NY; 3Icahn School of Medicine at Mount Sinai, Clayton, MO; 4Mount Sinai Hospital, Astoria, NY; 5Mount Sinai Hospital, New York, NY
Introduction: Infected pancreatic necrosis (IPN) is a major contributor to morbidity and mortality in patients with necrotizing pancreatitis (NP). While pancreatic fungal infection (PFI) has frequently been identified in patients with NP, its effect on clinical outcomes is unclear. Methods: A literature search was performed in Medline (Ovid), Embase (Ovid) and the Cochrane library. PRISMA guidelines for reporting of meta-analyses were adopted for the screening strategy. All prospective and retrospective studies that examined the incidence of fungal infection in NP with subgroup mortality data were included. For fungal infection of NP, studies with fungal isolation from pancreatic necrotic tissue were included. Statistical heterogeneity among selected studies was estimated using I2 and Q test. Results: Twenty-two studies comprising 2151 subjects were included for the quantitative analysis. Mean incidence of fungal infection in the pooled sample with NP was 24.7%. Odds ratio (OR) of mortality in NP patients with fungal infection was 3.95 (OR 3.95, 95% confidence interval [CI] 2.6-5.8) compared to those without fungal infection. In a separate analysis of seven studies, mean difference in the length of stay (LoS) between those with and without fungal infection was 22.99 days (95% CI 14.67-31.3). Five studies reported the rate of ICU admission (OR 3.95; 95% CI 2.6-5.8), four had data on prophylactic antibacterial use (OR 2.76; 95% CI 1.31-5.81) and five noted the duration of antibacterial therapy (mean difference 8.71 days; 95% CI 1.33-16.09) which were all significantly higher in the pooled sample of NP patients with PFI compared to those without. There was no significant difference in the use of TPN between the two subgroups (mean difference of 1.99%; 95% CI 0.69-5.69). Moderate heterogeneity was identified amongst the studies on estimating OR for mortality (I2=43%) between the two groups. There was low level of heterogeneity among studies estimated for LOS (I2=0%) and rate of ICU admission (I2=2.7%). Discussion: PFI in patients with NP is common and is associated with increased mortality, ICU admission rate, and LoS. Prophylactic antifungal therapy has been shown to reduce the incidence of fungal infection in severe acute pancreatitis, but without improvement in survival. Current guidelines do not recommend routine antifungal use to prevent fungal infection in necrotizing pancreatitis, although consideration should be given to those at highest risk.
Disclosures: Ritu Singh indicated no relevant financial relationships. Yakira David indicated no relevant financial relationships. Antonio Cheesman indicated no relevant financial relationships. Rebekah Dixon indicated no relevant financial relationships. Satish Nagula indicated no relevant financial relationships. Christopher DiMaio indicated no relevant financial relationships. David Greenwald indicated no relevant financial relationships. Nikhil Kumta indicated no relevant financial relationships.