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The microbiology of infected pancreatic necrosis in the era of minimally invasive therapy

  • Nadav Sahar
  • Richard A. Kozarek
  • Zaheer S. Kanji
  • Shingo Chihara
  • S. Ian Gan
  • Shayan Irani
  • Michael Larsen
  • Andrew S. Ross
  • Michael Gluck
Original Article

Abstract

We aimed to determine the microbiology of infected walled-off pancreatic necrosis (WON) in an era of minimally invasive treatment, since current knowledge is based on surgical specimens performed over two decades ago. We retrospectively analyzed a prospectively maintained database of patients who were treated for symptomatic WON using combined endoscopic and percutaneous drainage between 2008 and 2017. Aspirates from WON at initial treatment were evaluated. One hundred eighty-two patients were included with a mean age of 56 of whom 67% were male. Culture results were obtained at a median of 45 days from onset of acute pancreatitis of which 41% were infected. Candida spp. accounted for 27%; yet, multidrug-resistant organisms were found in only five patients. Approximately 64% were transferred to our institution for continuation of care. Of those, 55% were infected, most frequently with Candida spp., Enterococcus spp., and coagulase-negative Staphylococcus. Patients seen and admitted initially at our institution had milder forms of pancreatitis, fewer comorbidities, and 85% had symptomatic sterile WON. Empiric antibiotic use successfully predicted infection 70% of the time. Multivariate analysis demonstrated that elderly age, severity of pancreatitis, and prior use of antibiotics were indicators of infection. Necrotic pancreatic tissue remains sterile in the majority of cases treated with minimally invasive therapy, enabling judicious selection of antibiotics. Candida and Enterococcus spp. were common. Patients at highest risk for infection were previously treated with antibiotics and those transferred from outside institutions.

Keywords

Necrotizing pancreatitis Walled-off necrosis Candida Minimally invasive therapy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board at Virginia Mason Medical Center.

Informed consent

A waver for informed consent was approved by the IRB due to the study’s retrospective design.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Digestive Disease InstituteVirginia Mason Medical CenterSeattleUSA
  2. 2.Section of Infectious Diseases, Department of Internal MedicineVirginia Mason Medical CenterSeattleUSA

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