Infection recurrence following minimally invasive treatment in patients with infectious pancreatic necrosis

BACKGROUND In recent decades,an increasing number of patients have received minimally invasive intervention for infected pancreatic necrosis(IPN)because of the benefits in reducing postoperative multiple organ failure and mortality.However,there are limited published data regarding infection recurrence after treatment of this patient population.AIM To investigate the incidence and prediction of infection recurrence following successful minimally invasive treatment in IPN patients.METHODS Medical records for 193 IPN patients,who underwent minimally invasive treatment between February 2014 and October 2018,were retrospectively reviewed.Patients,who survived after the treatment,were divided into two groups:one group with infection after drainage catheter removal and another group without infection.The morphological and clinical data were compared between the two groups.Significantly different variables were introduced into the correlation and multivariate logistic analysis to identify independent predictors for infection recurrence.Sensitivity and specificity for diagnostic performance were determined.RESULTS Of the 193 IPN patients,178 were recruited into the study.Of them,9(5.06%)patients died and 169 patients survived but infection recurred in 13 of 178 patients(7.30%)at 7(4-10)d after drainage catheters were removed.White blood cell(WBC)count,serum C-reactive protein(CRP),interleukin-6,and procalcitonin levels measured at the time of catheter removal were significantly higher in patients with infection than in those without(all P<0.05).In addition,drainage duration and length of the catheter measured by computerized tomography scan were significantly longer in patients with infection(P=0.025 and P<0.0001,respectively).Although these parameters all correlated positively with the incidence of infection(all P<0.05),only WBC,CRP,procalcitonin levels,and catheter length were identified as independent predictors for infection recurrence.The sensitivity and specificity for infection prediction were high in WBC count(≥9.95×109/L)and serum procalcitonin level(≥0.05 ng/mL)but moderate in serum CRP level(cut-off point≥7.37 mg/L).The catheter length(cut-off value≥8.05 cm)had a high sensitivity but low specificity to predict the infection recurrence.CONCLUSION WBC count,serum procalcitonin,and CRP levels may be valuable for predicting infection recurrence following minimally invasive intervention in IPN patients.These biomarkers should be considered before removing the drainage catheters.

Real-world insights for the evolving intervention strategy for non-mild acute pancreatitis:35-year experience in a Chinese Tertiary Center

Background:With the accumulation of experience and evidence,guidelines for invasive intervention for acute pancreatitis(AP)have continuously evolved,followed in Peking Union Medical College Hospital(PUMCH).We aimed to review AP case series to help understand the impact of guideline evolution on the management and prognosis of AP in real-world practice.Methods:This was a single-center study of AP patients who had received invasive interventions from 1988 to 2022.Patient demographics,baseline severity,imaging findings,and the indication,timing,and specific modalities of invasive interventions were collected.The composite primary endpoint was death during hospitalization or major complications after intervention.Other endpoints included pancreatic fistula,incision infection,number of interventions,length of intensive care stay,length of hospitalization,and total medical cost.Results:A total of 195 patients were included.The most common indication for invasive intervention was suspected infection,followed by persistent symptoms.The step-up and delayed strategies reduced the incidence of major complications or death.Over 35 years,the number of patients requiring surgery has gradually declined,and more patients need only minimally invasive procedures for remission.The incidence of the primary outcome decreased as well as the duration of hospitalization.Conclusions:The management of AP patients at PUMCH in the last 35 years has undergone therapeutic guideline changes that support the efficacy and safety of the deferred step-up strategy in real-world practice.