Escherichia coli infection indicates favorable outcomes in patients with infected pancreatic necrosis

Haosu Huang; Jie Peng; Caihong Ning; Qin Wei; Jiarong Li; Chiayen Lin; Zefang Sun; Lu Chen; Shuai Zhu; Dingcheng Shen; Gengwen Huang

doi:10.3389/fcimb.2023.1107326

Escherichia coli infection indicates favorable outcomes in patients with infected pancreatic necrosis

Front Cell Infect Microbiol. 2023 Mar 27:13:1107326. doi: 10.3389/fcimb.2023.1107326. eCollection 2023.

Authors

Haosu Huang^{1

2}, Jie Peng^{1

2}, Caihong Ning^{2

3

4}, Qin Wei^{2

3

4}, Jiarong Li^{2

3

4}, Chiayen Lin^{2

3

4}, Zefang Sun^{2

3

4}, Lu Chen^{2

3

4}, Shuai Zhu^{2

3

4}, Dingcheng Shen^{2

3

4}, Gengwen Huang^{2

3

4}

Affiliations

¹ Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
² National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
³ Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁴ Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.

Abstract

Introduction: Infected pancreatic necrosis (IPN) is a severe complication of acute necrotizing pancreatitis with increasing morbidity. Escherichia coli is the most frequently cultured microorganism in IPN. However, the implications of Escherichia coli infection on the outcomes of patients with IPN remain unclear. Therefore, this study aimed to evaluate the clinical impacts of Escherichia coli infection on IPN.

Methods: A prospective database with consecutive patients with IPN between January 2010 and April 2022 at a tertiary hospital was post-hoc analyzed. The clinical and microbiological characteristics, surgical management, and follow-up data of patients with and without Escherichia coli infection were compared.

Results: A total of 294 IPN patients were enrolled in this cohort. Compared with non-Escherichia coli infection cases (n=80, 27.2%), patients with Escherichia coli infection (n=214, 72.8%) were characterized by more frequent polymicrobial infections (77.5% vs. 65.0%, P=0.04) but a lower occurrence of severe acute pancreatitis (SAP) (42.5% vs. 61.7%, P=0.003). In addition, significantly lower mortality (12.5% vs. 30.4%, p=0.002), fewer step-up surgical interventions (73.8% vs. 85.1%, P=0.025), and a lower rate of multiple organ failure (MOF) (25.0% vs. 40.2%, P=0.016) were also observed in patients with Escherichia coli infection. Multivariate analysis of mortality predictors indicated that MOF (odds ratio [OR], 6.197; 95% confidence interval [CI], 2.373-16.187; P<0.001) and hemorrhage (OR, 3.485; 95% CI, 1.623-7.487; P=0.001) were independent predictors associated with higher mortality in patients with IPN. Escherichia coli infection was significantly associated with a lower mortality (OR, 0.302; 95% CI, 0.121-0.751; P= 0.01).

Conclusion: Escherichia coli infection indicates a favorable prognosis in patients with IPN, although the mechanism needs further investigation.

Keywords: Escherichia coli; acute pancreatitis; infected pancreatic necrosis; mortality; outcomes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Bacterial Infections* / microbiology
Escherichia coli Infections* / complications
Escherichia coli Infections* / epidemiology
Humans
Pancreatitis, Acute Necrotizing* / complications
Pancreatitis, Acute Necrotizing* / surgery

Grants and funding

This study was supported financially by the Natural Science Foundation of Hunan Province (2020JJ4133).