Introduction
Infections in acute pancreatitis are associated with increased morbidity, mortality, and healthcare costs. Early diagnosis is essential to improve prognosis and reduce mortality. The aim of the present study is to evaluate the distribution of infectious complications according to the underlying etiology.
Aims & Methods
A retrospective analysis was conducted on a prospective database comprising a cohort of 526 patients with acute pancreatitis, consecutively included between March 2017 and June 2019 at a tertiary care hospital. All patients underwent systematic blood testing at admission and at 48 hours. Clinical management adhered to standard clinical practice guidelines. Diagnosis and classification were based on the revised 2012 Atlanta classification. Infectious complications were analyzed in patients with biliary and alcohol-related acute pancreatitis.
Results
Variable
| Overall (n = 526)
| Biliary (n = 304)
| Alcohol-related (n = 39)
| p-value
|
Acute cholangitis (Tokyo-18)
|
Suspected and/or confirmed
| 173 (37.6%)
| 140 (53.8%)
| 8 (20.4%)
| 0.001 **
|
Confirmed cases only
| 49 (29.2%)
| 43 (30.7%)
| 0
| 0.059
|
Antibiotic therapy
| 165 (36.1%)
| 123 (41.3%)
| 9 (23.7%)
| 0.037 **
|
| Extrapancreatic infections (Total) | 48 (14.3%)
| 34 (15.2%)
| 3 (13%)
| 1.000
|
Pneumonia
| 16 (4.8%)
| 8 (2.6%)
| 1 (2.6%)
| 1.000
|
Urinary tract infection
| 28 (8.4%)
| 25 (8.2%)
| 1 (2.6%)
| 0.335
|
Phlebitis / Catheter-related infection
| 4 (1.2%)
| 1 (0.3%)
| 1 (2.6%)
| 0.215
|
Infected pancreatic necrosis
| 11 (2.4%)
| 6 (2.1%)
| 2 (5.3%)
| 0.230
|
The distribution of infectious complications occurring during hospitalization is shown in Table 1. Up to 53.8% of patients with biliary acute pancreatitis presented with acute cholangitis according to the Tokyo-18 criteria, whereas this occurred in only 20.4% of alcohol-related cases. All cases of cholangitis in the alcoholic pancreatitis group, as well as the majority of those in the biliary group, met only the criteria for suspected acute cholangitis (100% vs. 53.8%, respectively). Antibiotic therapy was used in 41.3% of biliary pancreatitis cases, with a statistically significant difference compared to alcohol-related pancreatitis (23.7%). No significant differences were observed in the rates of extrapancreatic infections between the two groups, occurring in 15.2% and 13% of biliary and alcohol-related cases, respectively.
Conclusion
Extrapancreatic infections play a key role in the clinical course of acute pancreatitis, particularly in moderate and severe cases. The most frequent sites of infection include the respiratory and urinary tracts, as well as bloodstream infections. These infections are associated with an increased risk of complications, prolonged hospital stays, and higher mortality.
The characteristics of infections vary according to the etiology of pancreatitis. In our cohort, biliary pancreatitis was significantly more often associated with acute cholangitis, which is consistent with the pathophysiology of biliary-origin pancreatitis. Among patients with alcohol-related pancreatitis, up to 20% met criteria for suspected cholangitis; however, none fulfilled the criteria for confirmed cholangitis. This may be explained by the presence of acute-phase reactants and transient cholestasis, potentially leading to the administration of unnecessary antibiotic therapy.
Although previous studies have reported higher rates of respiratory infections in alcohol-related acute pancreatitis, our data showed no significant differences in these infections—or in infectious complications overall—between the two etiologies.
References
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