Factors influencing the development of nosocomial pancreatic infection in severe acute pancreatitis

Background: Infectious complications account for approximately 80% of deaths in severe acute necrotizing pancreatitis. The objective of our study was to determine the role of invasive procedures for the development of infected pancreas necrosis with bacteria resistant to first-line antibiotics. Patients and Methods: For the present investigation, a prospective, nonrandomized study design was used. The study population consisted of 47 consecutive patients with severe necrotizing pancreatitis. Data related to infectious complications was collected, and statistical analysis was performed to reveal factors influencing the occurrence of infected necrosis induced by bacteria resistant to first-line antibiotics. Results: Our study showed a biphasic mode of the disease, with infectious complications manifesting on the 3rd-4th week after onset of pancreatitis. Statistical analysis revealed that early fine needle aspiration (FNA) of pancreatic necrosis (days 8-14 of disease) and prolonged duration of central venous (CV) catheterization were independent risk factors for development of infected necrosis induced by bacteria resistant to first-line antibiotics, but the latter had an even stronger relationship to the occurrence of generalized septicemia. Conclusion: FNA of pancreatic necrosis during the first 2 weeks after onset of acute pancreatitis is a risk factor for development of infected necrosis induced by bacteria resistant to first-line antibiotics. Ultrasound-guided aspirations should only be performed in patients with signs of sepsis.