Infection Tied to Higher Mortality in Pancreatitis

Patients with acute pancreatitis who develop a hospital-acquired infection have significantly higher mortality and health care costs, as well as longer hospital stays, compared with similar patients without infection.

Using the Cardinal Health Clinical Outcomes Research Database (a large database that tracks information on hospitalized patients), Dr. Bechien U. Wu and colleagues identified 11,046 cases of acute pancreatitis at 177 hospitals between January 2004 and January 2005. Of those, 81 patients who developed a hospital-acquired infection (HAI) were each matched with 5 similar patients who did not have a HAI.

The HAI patients and the controls were propensity matched according to their likelihood to develop an infection.

The median age was 53 years in the larger cohort, 60 years in the control patients, and 63 years in the patients with HAI. About half of the patients were men.

Mortality in the patients with HAI was 28%, compared with 11% in the 405 control patients and 1% in the overall acute pancreatitis population, according to Dr. Wu of Harvard Medical School and the division of gastroenterology at Brigham and Women's Hospital, both in Boston, and colleagues. Of the 150 deaths in the entire group of acute pancreatitis patients, 23 (15%) were in HAI patients.

Because HAI may be associated with other factors that could affect mortality, the researchers examined initial disease severity, organ failure, and invasive procedures performed in these patients. Compared with all acute pancreatitis patients, HAI patients had higher initial disease scores on the APACHE (Acute Physiology and Chronic Health Evaluation) II measure; had greater frequency of procedures that indicated organ failure, such as mechanical ventilation and hemodialysis; and more often received placement of central venous catheters and total parenteral nutrition. However, these differences were not significant when the HAI patients were compared with the control patients. Therefore, the authors concluded that the higher mortality was not the result of more severe disease in the HAI group (Clin. Gastroenterol. Hepatol. 2008 September [doi:10.1053/j.gastro.2008.05.053]).

Hospital-acquired infection was defined as “a localized or systemic infection resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s) that was not present or incubating at the time of hospital admission,” they wrote.

One limitation was that all the infections in the study were catheter- or ventilator-associated HAI, and other types of HAI were not investigated. In this study, catheter-associated urinary tract infections accounted for 36% of HAI, catheter-associated bloodstream infections accounted for 35%, ventilator-associated pneumonia accounted for 11%, and 16% of the infections occurred at multiple sites.

Mortality was highest (33%) for the nine patients with ventilator-associated pneumonia. The 31 patients with urinary tract infections had a mortality of 27%, and the 29 patients with bloodstream infections had a mortality of 28%, they reported.

Mean length of hospital stay in the overall group was 5.6 days, compared with 13.1 days in the control acute pancreatitis patients and 34.5 days in the patients with HAI. The mean health care bill came to $28,749 in the overall group, $102,607 in control patients, and $275,580 in HAI patients. These differences were significant.

Effective methods for reducing the incidence of HAI in acute pancreatitis patients have yet to be determined. In the only two randomized, controlled studies to date, prophylactic antibiotics did not reduce extrapancreatic infection or mortality, the investigators said.

HAI is an independent contributor to worse outcomes in acute pancreatitis patients, and “aggressive efforts to reduce HAI may lead to significantly improved outcomes for patients with acute pancreatitis,” Dr. Wu and colleagues concluded.

None of the authors had a financial conflict of interest to report.

Patients with acute pancreatitis who develop a hospital-acquired infection have significantly higher mortality and health care costs, as well as longer hospital stays, compared with similar patients without infection.

Using the Cardinal Health Clinical Outcomes Research Database (a large database that tracks information on hospitalized patients), Dr. Bechien U. Wu and colleagues identified 11,046 cases of acute pancreatitis at 177 hospitals between January 2004 and January 2005. Of those, 81 patients who developed a hospital-acquired infection (HAI) were each matched with 5 similar patients who did not have a HAI.

The HAI patients and the controls were propensity matched according to their likelihood to develop an infection.

The median age was 53 years in the larger cohort, 60 years in the control patients, and 63 years in the patients with HAI. About half of the patients were men.

Mortality in the patients with HAI was 28%, compared with 11% in the 405 control patients and 1% in the overall acute pancreatitis population, according to Dr. Wu of Harvard Medical School and the division of gastroenterology at Brigham and Women's Hospital, both in Boston, and colleagues. Of the 150 deaths in the entire group of acute pancreatitis patients, 23 (15%) were in HAI patients.

Because HAI may be associated with other factors that could affect mortality, the researchers examined initial disease severity, organ failure, and invasive procedures performed in these patients. Compared with all acute pancreatitis patients, HAI patients had higher initial disease scores on the APACHE (Acute Physiology and Chronic Health Evaluation) II measure; had greater frequency of procedures that indicated organ failure, such as mechanical ventilation and hemodialysis; and more often received placement of central venous catheters and total parenteral nutrition. However, these differences were not significant when the HAI patients were compared with the control patients. Therefore, the authors concluded that the higher mortality was not the result of more severe disease in the HAI group (Clin. Gastroenterol. Hepatol. 2008 September [doi:10.1053/j.gastro.2008.05.053]).

Hospital-acquired infection was defined as “a localized or systemic infection resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s) that was not present or incubating at the time of hospital admission,” they wrote.

One limitation was that all the infections in the study were catheter- or ventilator-associated HAI, and other types of HAI were not investigated. In this study, catheter-associated urinary tract infections accounted for 36% of HAI, catheter-associated bloodstream infections accounted for 35%, ventilator-associated pneumonia accounted for 11%, and 16% of the infections occurred at multiple sites.

Mortality was highest (33%) for the nine patients with ventilator-associated pneumonia. The 31 patients with urinary tract infections had a mortality of 27%, and the 29 patients with bloodstream infections had a mortality of 28%, they reported.

Mean length of hospital stay in the overall group was 5.6 days, compared with 13.1 days in the control acute pancreatitis patients and 34.5 days in the patients with HAI. The mean health care bill came to $28,749 in the overall group, $102,607 in control patients, and $275,580 in HAI patients. These differences were significant.

Effective methods for reducing the incidence of HAI in acute pancreatitis patients have yet to be determined. In the only two randomized, controlled studies to date, prophylactic antibiotics did not reduce extrapancreatic infection or mortality, the investigators said.

HAI is an independent contributor to worse outcomes in acute pancreatitis patients, and “aggressive efforts to reduce HAI may lead to significantly improved outcomes for patients with acute pancreatitis,” Dr. Wu and colleagues concluded.

None of the authors had a financial conflict of interest to report.

Patients with acute pancreatitis who develop a hospital-acquired infection have significantly higher mortality and health care costs, as well as longer hospital stays, compared with similar patients without infection.

Using the Cardinal Health Clinical Outcomes Research Database (a large database that tracks information on hospitalized patients), Dr. Bechien U. Wu and colleagues identified 11,046 cases of acute pancreatitis at 177 hospitals between January 2004 and January 2005. Of those, 81 patients who developed a hospital-acquired infection (HAI) were each matched with 5 similar patients who did not have a HAI.

The HAI patients and the controls were propensity matched according to their likelihood to develop an infection.

The median age was 53 years in the larger cohort, 60 years in the control patients, and 63 years in the patients with HAI. About half of the patients were men.

Mortality in the patients with HAI was 28%, compared with 11% in the 405 control patients and 1% in the overall acute pancreatitis population, according to Dr. Wu of Harvard Medical School and the division of gastroenterology at Brigham and Women's Hospital, both in Boston, and colleagues. Of the 150 deaths in the entire group of acute pancreatitis patients, 23 (15%) were in HAI patients.

Because HAI may be associated with other factors that could affect mortality, the researchers examined initial disease severity, organ failure, and invasive procedures performed in these patients. Compared with all acute pancreatitis patients, HAI patients had higher initial disease scores on the APACHE (Acute Physiology and Chronic Health Evaluation) II measure; had greater frequency of procedures that indicated organ failure, such as mechanical ventilation and hemodialysis; and more often received placement of central venous catheters and total parenteral nutrition. However, these differences were not significant when the HAI patients were compared with the control patients. Therefore, the authors concluded that the higher mortality was not the result of more severe disease in the HAI group (Clin. Gastroenterol. Hepatol. 2008 September [doi:10.1053/j.gastro.2008.05.053]).

Hospital-acquired infection was defined as “a localized or systemic infection resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s) that was not present or incubating at the time of hospital admission,” they wrote.

One limitation was that all the infections in the study were catheter- or ventilator-associated HAI, and other types of HAI were not investigated. In this study, catheter-associated urinary tract infections accounted for 36% of HAI, catheter-associated bloodstream infections accounted for 35%, ventilator-associated pneumonia accounted for 11%, and 16% of the infections occurred at multiple sites.

Mortality was highest (33%) for the nine patients with ventilator-associated pneumonia. The 31 patients with urinary tract infections had a mortality of 27%, and the 29 patients with bloodstream infections had a mortality of 28%, they reported.

Mean length of hospital stay in the overall group was 5.6 days, compared with 13.1 days in the control acute pancreatitis patients and 34.5 days in the patients with HAI. The mean health care bill came to $28,749 in the overall group, $102,607 in control patients, and $275,580 in HAI patients. These differences were significant.

Effective methods for reducing the incidence of HAI in acute pancreatitis patients have yet to be determined. In the only two randomized, controlled studies to date, prophylactic antibiotics did not reduce extrapancreatic infection or mortality, the investigators said.

HAI is an independent contributor to worse outcomes in acute pancreatitis patients, and “aggressive efforts to reduce HAI may lead to significantly improved outcomes for patients with acute pancreatitis,” Dr. Wu and colleagues concluded.

None of the authors had a financial conflict of interest to report.