Analysis of clinical characteristics and risk factors of 120 patients of severe acute pancreatitis with secondary fungal infection / 中华消化杂志

ABSTRACT

Objective:To analyze the clinical characteristics and risk factors of fungal infections secondary to severe acute pancreatitis (SAP), so as to provide experience for clinical diagnosis and treatment.Methods:From January 2013 to August 2020, at The First Affiliated Hospital of Chongqing Medical University, 48 SAP patients with secondary fungal infection (infection group) were enrolled. At the same period, 72 SAP patients without fungal infection (non-infection group) were selected as control group. The location of fungal infection, bacterial species distribution, anti-fungal treatment of the infection group, and the prognosis of the two groups were analyzed. Independent sample t test, Wilcoxon rank sum test and chi-square test were used for statistical analysis. The factors that may affect the secondary fungal infection of SAP were analyzed by binary logistic regression analysis in order to detect the independent risk factors of SAP with secondary fungal infection, and receiver operating characteristic curve analysis was performed to evaluate their value in predicting SAP with secondary fungal infection. Results:There were 74 fungal infection sites in the infection group, mainly respiratory infections (25.7%); 54 fungal strains were isolated and all of which were Candida infection, mainly Candida albicans (48.1%). In the infection group, 36 patients received antifungal therapy, among whom 20 patients (55.6%) died; the remaining 12 patients did not receive antifungal therapy, six of them died, in total 26 (54.2%) patients died. In the non-infection group there were nine patients (12.5%) died. There was a significant difference in mortality between the infection group and the non-infection group (54.2% vs. 12.5%, χ2=24.20, P<0.01). Compared with the non-infection group, the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score at admission, time of fasting and drinking, time of urinary catheter catheterization and deep venous catheterization, types and duration of broad-spectrum antibiotics usage, hospital stay, time of invasive ventilator using and indwelling time of abdominal drainage tube were higher in the infection group ((16.92±5.70) point vs. (13.32±4.73) point, (16.38±6.87) d vs. (9.51±4.90) d, (15.65±9.68) d vs. (10.40±9.45) d, (19.48±10.43) d vs. (12.74±10.28) d, (4.13±1.02) type vs. (2.35±1.78) type, (30.54±12.94) d vs.(19.10±9.48) d, (36.10±26.27) d vs.(21.93±9.91) d, 6.00 d (0.00 d, 21.75 d) vs. 0.00 d(0.00 d, 7.00 d), 9.00 d (0.00 d, 18.00 d) vs. 0.00 d (0.00 d, 0.00 d)), and the differences were statistically significant ( t=-3.61, -6.56, -3.08, -3.82, -6.86, -5.06 and -3.95, Z=-2.71 and -4.19, all P<0.01). The results of binary logistic regression analysis showed that APACHEⅡ score at admission, time of fasting and drinking, and broad-spectrum antibiotic usage were independent risk factors of SAP with secondary fungal infection (odds ratio=1.181, 2.589 and 1.205, 95% confidence interval ( CI) 1.036 to 1.347, 1.409 to 4.757 and 1.060 to 1.370), and the differences were statistically significant (all P<0.05). The area under curve values of APACHEⅡ score, broad-spectrum antibiotics usage and time of fasting and drinking were 0.695 (95% CI 0.596 to 0.794), 0.853 (95% CI 0.784 to 0.923) and 0.907 (95% CI 0.798 to 0.923), respectively; and the cut-off values at 17.5 point, 3.5 types, and 11.5 d were most effective in predicting secondary fungal infection of SAP. Conclusions:Respiratory tract is the most common site for secondary fungal infections in SAP. Candida albicans infection is more common. SAP patients with APACHE Ⅱ score >17 point at admission, time of fasting and drinking >11 d and more than three kinds of broad-spectrum antibiotics application are prone to secondary fungal infections in the later stage.