Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis

Table 1 Comparison of baseline demographic and clinical characteristics between the infection group and non-infection group

Variable	Total (n = 205)	Infection (n = 163)	Non-infection (n = 42)	P-value
Age (yr)	49.5 ± 15.7	50.3 ± 15.5	46.6 ± 16.7	0.173
Male	140	112	28	0.801
Etiology				0.898
Biliary	109	88	21
Alcohol	10	7	3
Hyperlipemia	67	52	15
ERCP	6	5	1
Others	13	11	2
Referral time	24 (0-300)	30 (0-300)	2.5 (0-180)	0.013a
CTSI	4 (2-10)	6 (2-10)	4 (2-8)	0.127
Persistent OF	50	49	1	0.005b
Need for any intervention	120	113	7	< 0.001c
Death	20	18	2	0.191
TPN	17 (0-163)	18 (0-163)	10 (0-47)	< 0.001c
EN	1 (0-112)	2 (0-112)	0 (0-34)	0.004b
Length of hospital stay(d)	29 (0-172)	32 (0-172)	19 (5-48)	< 0.001c
Length of stay ICU stay	11 (0-117)	13 (0-28)	7 (0-117)	0.004b
Necrosis degree				0.018a
< 30%	40	26	14
30%-50%	80	65	15
> 50%	85	72	13

^aP < 0.05,

^bP < 0.01,

^cP < 0.001. ERCP: Endoscopic retrograde cholangio pancreatography; CTSI: Computer tomography severity scan; OF: Organ failure; TPN: Total parenteral nutrition; EN: Enteral nutrition; ICU: Intensive care unit.

Table 2 Microbiological profile of organisms in infected patients

Organism	INP (n = 212)	Extrapancreatic infection (n = 327)
Gram-negative
P. aeruginosa	34	32
A. baumanii	22	22
E. coli	34	20
K. pneumoniae	30	16
Gram-positive
S. epidermidis	5	32
E. faecium	18	30
S. haemolyticus	5	19
S. aureus	5	8
Fungal
C. albicans	3	19
C. parapsilosis	0	12
C. tropicalis	0	12
C. glabrata	1	9

INP: Infectious necrotizing pancreatitis; E. coli: Escherichia coli; P. aeruginosa: Pseudomonas aeruginosa; A. baumannii: Acinetobacter baumannii; K. pneumoniae: Klebsiella pneumoniae; E. faecium: Enterococcus faecium; S. epidermidis: Staphylococcus epidermidis; S. aureus: Staphylococcus aureus; E. faecalis: Enterococcus faecalis; C. albicans: Candida albicans; C. parapsilosis: Candida parapsilosis; C. tropicalis: Candida tropicalis; C. glabrata: Candida glabrata.

Table 3 Drug sensitivity of Gram-negative bacteria in infected patients

	Pancreatic				Extrapancreatic
Antibiotic	P. aeruginosa	E. coli	A. baumannii	K. pneumoniae	P. aeruginosa	E. coli	A. baumannii	K. pneumoniae
MDR bacteria	9/34	9/34	16/22	15/30	8/32	4/20	17/22	11/16
ESBL +:	—	14/34	—	6/30	—	10/20	—	2/16
Penicillins
Ampicillin	0/34	8/34	0/22	1/30	0/32	4/20	1/22	0/16
Piperacillin	12/34	4/34	0/22	3/30	14/32	4/20	1/22	0/16
Enzymatic penicillins
Piperacillin/tazobactam	13/34	10/34	4/22	8/30	19/32	11/20	1/22	4/16
Cefoperazone/sulbactam	8/34	0/34	4/22	0/30	9/32	0/20	4/22	0/16
Ampicillin/sulbactam	0/34	4/34	0/22	4/30	0/32	6/20	4/22	0/16
quinolones
Levofloxacin	21/34	11/34	3/22	11/30	17/32	6/20	3/22	3/16
First- and second-generation cephalosporins
Cefoxitin	0/34	0/34	0/22	0/30	0/32	0/20	0/22	0/16
Cefuroxime	0/34	0/34	0/22	0/30	0/32	0/20	0/22	0/16
Third- and fourth-generation cephalosporins
Ceftazidime	14/34	13/34	3/22	7/30	16/32	11/20	3/22	2/16
Cefepime	17/34	12/34	3/22	10/30	15/32	11/20	3/22	3/16
Carbapenems
Imipenem	10/34	21/34	2/22	11/30	10/32	12/20	3/22	2/16
Meropenem	10/34	11/34	3/22	6/30	9/32	6/20	3/22	2/16
Sulfonamides
Compound trimethoprim	1/34	14/34	9/22	14/30	0/32	10/20	8/22	9/16
Tetracycline
Tigecycline	1/34	1/34	17/22	13/30	0/32	2/20	18/22	9/16
Minocycline	—	—	9/22	—	0/32	—	10/22	—

MDR: Multidrug-resistant; ESBL: Extended-spectrum β-lactamases; E. coli: Escherichia coli; P. aeruginosa: Pseudomonas aeruginosa; A. baumannii: Acinetobacter baumannii; K. pneumoniae: Klebsiella pneumoniae.

Table 4 Drug sensitivity of Gram-positive bacteria in infected patients

		Pancreatic				Extrapancreatic
Antibiotic	E. faecium	S. epidermidis	S. aureus	E. faecalis	E. faecium	S. epidermidis	S. aureus	E. faecalis
MDR bacteria	5/18	0/5	2/5	3/6	4/30	1/32	3/8	0/5
ESBL +:	—	3/5	3/5	—	—	12/32	3/8	—
Penicillins
Ampicillin	2/18	0/5	0/5	3/6	1/30	0/32	0/8	3/5
Penicillin G	0/18	0/5	0/5	1/6	0/30	0/32	0/8	3/5
quinolones
Ciprofloxacin	1/18	0/5	0/5	1/6	0/30	8/32	3/8	3/5
Levofloxacin	2/18	0/5	0/5	1/6	1/30	8/32	3/8	3/5
Moxifloxacin	1/18	2/5	0/5	1/6	1/30	21/32	3/8	3/5
Macrolactones
Linezolid	14/18	5/5	4/5	5/6	25/30	31/32	8/8	4/5
Tetracycline
Tigecycline	17/18	5/5	5/5	5/6	27/30	32/32	8/8	5/5
Sulfonamides
Compound trimethoprim	1/18	1/5	4/5	0/6	2/30	9/32	6/8	2/5
Polypeptides
Vancomycin	11/18	5/5	5/5	6/6	25/30	31/32	8/8	5/5

MDR: Multidrug-resistant; ESBL: Extended-spectrum β-lactamase; E. faecium: Enterococcus faecium; S. epidermidis: Staphylococcus epidermidis; S. aureus: Staphylococcus aureus; E. faecalis: Enterococcus faecalis.

Table 5 Multivariable analysis for independent predictors of mortality

Variable	Univariable analysis	P-value	Multivariable analysis	P-value
	OR (95%CI)		OR (95%CI)
Persistent OF	5.37 (3.785-7.618)	< 0.001	0.012 (0.001-0.101)	< 0.001c
MDR organism (s)	2.445 (1.554-3.848)	0.001	0.134 (0.028-0.633)	0.011b
Fungal infection	2.719 (1.498-4.936)	0.002	0.657 (0.156-2.770)	0.567
Prophylactic antibiotic	0.974 (0.783-1.210)	0.8	0.534 (0.095-2.989)	0.475
INP	1.151 (0.802-1.651)	0.48	0.277 (0.024-3.234)	0.306
Extrapancreatic infection	1.383 (1.124-1.704)	0.031	0.627 (0.042-9.273)	0.734
Referred patients	1.102 (0.986-1.232)	0.25	0.524 (0.041-6.655)	0.619
Operation	0.789 (0.497-1.255)	0.262	10.533 (1.052-105.491)	0.045a
Complication	2.921 (1.304-6.540)	0.011	0.892 (0.191-4.162)	0.885

^aP < 0.05,

^bP < 0.01,

^cP < 0.001. OF: Organ failure; INP: Infectious necrotizing pancreatitis; TPN: Total parenteral nutrition; EN: Enteral nutrition; CI: Confidence interval; OR: Odds ratio; MDR: Multidrug-resistant.