Candidemia indicates poor outcome in patients with infected pancreatic necrosis.

BACKGROUND Intra-abdominal fungal infection (AFI) and candidemia are common in patients with acute pancreatitis (AP), but with limited and conflicting reports on their clinical impacts. This study aims to evaluate the clinical impacts of AFI and candidemia in infected pancreatic necrosis (IPN). METHODS A single-center, prospective cohort including 235 consecutive patients with IPN between January 2010 and September 2020 was analyzed to study the clinical impacts of AFI and candidemia. RESULTS Of the 235 patients with IPN, 69 patients (29.4%) developed AFI and 13 patients (5.5%) developed candidemia. AFI was associated with higher intestinal leakage rate (27.5% vs 12.7%, P=0.006), higher pancreatic fistula rate (53.6% vs 34.3%, P=0.006), and longer hospital stays (72 vs 58 days, P=0.003), but with similar mortality rate compared with patients without AFI (23.2% vs 24.7%, P=0.806). However, candidemia was associated with significantly higher mortality rate compared with patients without candidemia (69.2% vs 21.6%, P<0.001). Patients with candidemia had higher rate of multiple organ failure and AFI (69.2% vs 36.5%, P=0.018; 69.2% vs 27.0%, P=0.001, respectively). Multivariable analysis showed that age≥50 years (OR=2.8; 95% CI, 1.3-5.8; P=0.007), severe category (OR=11.2; 95% CI, 3.5-35.7; P<0.001), multidrug-resistant organisms infection (OR=2.5; 95% CI, 1.0-6.2; P=0.039), candidemia (OR=11.8; 95% CI, 2.5-56.5; P=0.002), step-down surgical approach (OR=3.2; 95% CI, 1.5-7.0; P=0.004) were the independent predictors associated with higher mortality in IPN patients. CONCLUSION Although AFI did not increase the mortality of IPN, patients with candidemia carried significantly higher mortality.