876. Multidrug resistant gram negative rod (MDR GNR) infection hinders outcome improvements in severe infected necrotizing pancreatitis
Session: Poster Abstract Session: Bone, Joint, and Soft Tissue Infection
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
Posters
  • IDSA Poster.pdf (384.2 kB)
  • Background: Outcomes following severe infected necrotizing pancreatitis (SINP) have improved, yet this disease process is still associated with a very high mortality. Progress over the last half century has stalled, despite advances in quaternary and multidisciplinary care. We analyzed our cohort of patients with SINP to elucidate targets for improvements in surgical and medical care.

    Methods: Retrospective review was performed of all patients with diagnosis of SINP from January 2006 through January 2012 in our high-volume quaternary referral center. Patient data was analyzed for demographics, treatment strategies, antibiotic use, outcomes, and mortality. Statistical analysis was performed using Fisher’s exact test for binary outcomes and Student’s t-test for continuous variables.

    Results: Forty patients (29 male) with SINP were identified with complete data. Overall mortality was 22.5% with multi-system organ failure as the predominant cause of death.  Average BISAP (bedside index for severity in acute pancreatitis) score was 2.19.  Eleven patients developed MDR GNR pancreatic infections. Compared to those patients without MDR GNR infection, mean treatment duration with either a carbapenem, cephalosporin, or piperacillin/tazobactam was significantly longer (44.5 days vs. 23.4 days, p=0.015).  In patients with MDR GNR infection, there was a trend towards increased mortality rates (45.4% vs. 13.8%, p=0.08) and bacteremia (45.4% vs. 20.1%, p=0.14) compared to those without MDR GNR infection.  Ninety-one percent of patients with MDR GNR infection required surgical intervention compared to 65% without (p=0.22). Average time to surgical intervention was longer in patients with MDR GNR infection (40.3 days vs. 37.6 days, p<0.001). 

    Conclusion: MDR GNR superinfection is identified as a significant risk factor in SINP and is at least in part responsible for lack of further improvement in treatment outcomes. Antibiotic duration and choice remains highly variable despite modern understanding and published consensus statements. MDR GNR SINP is associated with increased broad spectrum antibiotic usage. Protocolized treatment strategies and in-depth understanding of bacterial co-factors in SINP may provide a new starting point for improved outcomes.

    Erin Hanna, MD1, Catherine Passaretti, MD2, James Horton, MD2, Julie E. Williamson, PharmD3, John Martinie, MD1, David Iannitti, MD1 and David Sindram, MD, PhD1, (1)General Surgery, Carolinas Medical Center, Charlotte, NC, (2)Medicine, Carolinas Medical Center, Charlotte, NC, (3)Department of Pharmacy, Carolinas Medical Center, Charlotte, NC

    Disclosures:

    E. Hanna, None

    C. Passaretti, None

    J. Horton, GSK: Sub-Investigator, Research support
    Gilead: Sub-Investigator, Research support

    J. E. Williamson, None

    J. Martinie, None

    D. Iannitti, None

    D. Sindram, None

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