Risk factors for the development of intra-abdominal fungal infections in acute pancreatitis.

Objectives: Intra-abdominal fungal infections (AFIs) complicating acute pancreatitis arise in the context of pancreatic necrosis. Our goal was to determine which risk factors contribute to AFI in patients with acute pancreatitis.

Methods: Records were reviewed from 479 nontransfer patients admitted to our medical center with acute pancreatitis from 1985 to 2009. Using multivariable regression models, we identified risk factors for AFI.

Results: Of 479 patients admitted with acute pancreatitis, 17 patients were subsequently found to have an AFI and 3 of these patients died. The mean length of stay for patients with an AFI was 24 days, and 76% were admitted to the intensive care unit. The patients with AFI were more likely to have received prophylactic antibiotics on admission (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2-2.3) and total parenteral nutrition within 7 days of admission (OR, 1.4; 95% CI, 1.1-1.7) or to have necrosis on CT scan within 7 days of admission (OR, 1.4; 95% CI, 1.1-1.7). Multivariable regression models identified admission antibiotic use (OR, 1.6; 95% CI, 1.4-1.8) as the strongest predictor of AFI.

Conclusions: Admission antibiotics are the biggest risk factor for the development of intra-AFIs in acute pancreatitis. Prophylactic antibiotics to prevent infected necrosis should therefore be discouraged.