Impact of Antimicrobial Prophylaxis for Severe Acute Pancreatitis on the Development of Invasive Candidiasis

A Large Retrospective Multicenter Cohort Study

Masayasu Horibe, Masamitsu Sanui, Mitsuhito Sasaki, Hitoshi Honda, Yuki Ogura, Shin Namiki, Hirotaka Sawano, Takashi Goto, Tsukasa Ikeura, Tsuyoshi Takeda, Takuya Oda, Hideto Yasuda, Dai Miyazaki, Kaoru Hirose, Katsuya Kitamura, Nobutaka Chiba, Tetsu Ozaki, Takahiro Yamashita, Toshitaka Koinuma, Taku Oshima & 10 others Tomonori Yamamoto, Morihisa Hirota, Satoshi Yamamoto, Kyoji Oe, Tetsuya Ito, Yukiko Masuda, Nobuyuki Saito, Eisuke Iwasaki, Takanori Kanai, Toshihiko Mayumi

Research output: Contribution to journalArticle

Abstract

Objective Antimicrobial prophylaxis is not generally recommended for patients with severe acute pancreatitis (SAP) owing to the limited clinical benefits. Nonetheless, it is frequently administered in actual practice given the patients' critical condition and the lack of solid evidence showing adverse effects of antimicrobial prophylaxis. We evaluated herein an association between antimicrobial prophylaxis and invasive pancreatic candidiasis as an adverse effect in patients with SAP. Methods This is a retrospective cohort study of all consecutive patients with SAP who were admitted to the study institutions (n = 44) between January 1, 2009, and December 31, 2013. We performed multivariable logistic regression analysis adjusting for the extent of pancreatic necrosis and surgical interventions for invasive pancreatic candidiasis. Results Of the 1097 patients with SAP, 850 (77.5%) received antimicrobial prophylaxis, and 21 (1.9%) had invasive pancreatic candidiasis. In multivariable logistic regression analysis, antimicrobial prophylaxis was significantly associated with the development of invasive pancreatic candidiasis (adjusted odds ratio, 4.23; 95% confidence interval, 1.14-27.6) (P = 0.029). Conclusions The results suggest that antimicrobial prophylaxis may contribute to the development of invasive pancreatic candidiasis, and therefore, the routine use of antimicrobial prophylaxis for SAP may be discouraged.

Original languageEnglish
Pages (from-to)537-543
Number of pages7
JournalPancreas
Volume48
Issue number4
DOIs
Publication statusPublished - 2019 Apr 1

Fingerprint

Invasive Candidiasis
Pancreatitis
Multicenter Studies
Cohort Studies
Logistic Models
Regression Analysis
Necrosis
Retrospective Studies
Odds Ratio
Confidence Intervals

Keywords

  • acute necrotizing pancreatitis
  • acute pancreatitis
  • antimicrobial prophylaxis
  • Candida
  • fungal infection

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

Cite this

Impact of Antimicrobial Prophylaxis for Severe Acute Pancreatitis on the Development of Invasive Candidiasis : A Large Retrospective Multicenter Cohort Study. / Horibe, Masayasu; Sanui, Masamitsu; Sasaki, Mitsuhito; Honda, Hitoshi; Ogura, Yuki; Namiki, Shin; Sawano, Hirotaka; Goto, Takashi; Ikeura, Tsukasa; Takeda, Tsuyoshi; Oda, Takuya; Yasuda, Hideto; Miyazaki, Dai; Hirose, Kaoru; Kitamura, Katsuya; Chiba, Nobutaka; Ozaki, Tetsu; Yamashita, Takahiro; Koinuma, Toshitaka; Oshima, Taku; Yamamoto, Tomonori; Hirota, Morihisa; Yamamoto, Satoshi; Oe, Kyoji; Ito, Tetsuya; Masuda, Yukiko; Saito, Nobuyuki; Iwasaki, Eisuke; Kanai, Takanori; Mayumi, Toshihiko.

In: Pancreas, Vol. 48, No. 4, 01.04.2019, p. 537-543.

Research output: Contribution to journalArticle

Horibe, M, Sanui, M, Sasaki, M, Honda, H, Ogura, Y, Namiki, S, Sawano, H, Goto, T, Ikeura, T, Takeda, T, Oda, T, Yasuda, H, Miyazaki, D, Hirose, K, Kitamura, K, Chiba, N, Ozaki, T, Yamashita, T, Koinuma, T, Oshima, T, Yamamoto, T, Hirota, M, Yamamoto, S, Oe, K, Ito, T, Masuda, Y, Saito, N, Iwasaki, E, Kanai, T & Mayumi, T 2019, 'Impact of Antimicrobial Prophylaxis for Severe Acute Pancreatitis on the Development of Invasive Candidiasis: A Large Retrospective Multicenter Cohort Study', Pancreas, vol. 48, no. 4, pp. 537-543. https://doi.org/10.1097/MPA.0000000000001269
Horibe, Masayasu ; Sanui, Masamitsu ; Sasaki, Mitsuhito ; Honda, Hitoshi ; Ogura, Yuki ; Namiki, Shin ; Sawano, Hirotaka ; Goto, Takashi ; Ikeura, Tsukasa ; Takeda, Tsuyoshi ; Oda, Takuya ; Yasuda, Hideto ; Miyazaki, Dai ; Hirose, Kaoru ; Kitamura, Katsuya ; Chiba, Nobutaka ; Ozaki, Tetsu ; Yamashita, Takahiro ; Koinuma, Toshitaka ; Oshima, Taku ; Yamamoto, Tomonori ; Hirota, Morihisa ; Yamamoto, Satoshi ; Oe, Kyoji ; Ito, Tetsuya ; Masuda, Yukiko ; Saito, Nobuyuki ; Iwasaki, Eisuke ; Kanai, Takanori ; Mayumi, Toshihiko. / Impact of Antimicrobial Prophylaxis for Severe Acute Pancreatitis on the Development of Invasive Candidiasis : A Large Retrospective Multicenter Cohort Study. In: Pancreas. 2019 ; Vol. 48, No. 4. pp. 537-543.
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AU - Horibe, Masayasu

AU - Sanui, Masamitsu

AU - Sasaki, Mitsuhito

AU - Honda, Hitoshi

AU - Ogura, Yuki

AU - Namiki, Shin

AU - Sawano, Hirotaka

AU - Goto, Takashi

AU - Ikeura, Tsukasa

AU - Takeda, Tsuyoshi

AU - Oda, Takuya

AU - Yasuda, Hideto

AU - Miyazaki, Dai

AU - Hirose, Kaoru

AU - Kitamura, Katsuya

AU - Chiba, Nobutaka

AU - Ozaki, Tetsu

AU - Yamashita, Takahiro

AU - Koinuma, Toshitaka

AU - Oshima, Taku

AU - Yamamoto, Tomonori

AU - Hirota, Morihisa

AU - Yamamoto, Satoshi

AU - Oe, Kyoji

AU - Ito, Tetsuya

AU - Masuda, Yukiko

AU - Saito, Nobuyuki

AU - Iwasaki, Eisuke

AU - Kanai, Takanori

AU - Mayumi, Toshihiko

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N2 - Objective Antimicrobial prophylaxis is not generally recommended for patients with severe acute pancreatitis (SAP) owing to the limited clinical benefits. Nonetheless, it is frequently administered in actual practice given the patients' critical condition and the lack of solid evidence showing adverse effects of antimicrobial prophylaxis. We evaluated herein an association between antimicrobial prophylaxis and invasive pancreatic candidiasis as an adverse effect in patients with SAP. Methods This is a retrospective cohort study of all consecutive patients with SAP who were admitted to the study institutions (n = 44) between January 1, 2009, and December 31, 2013. We performed multivariable logistic regression analysis adjusting for the extent of pancreatic necrosis and surgical interventions for invasive pancreatic candidiasis. Results Of the 1097 patients with SAP, 850 (77.5%) received antimicrobial prophylaxis, and 21 (1.9%) had invasive pancreatic candidiasis. In multivariable logistic regression analysis, antimicrobial prophylaxis was significantly associated with the development of invasive pancreatic candidiasis (adjusted odds ratio, 4.23; 95% confidence interval, 1.14-27.6) (P = 0.029). Conclusions The results suggest that antimicrobial prophylaxis may contribute to the development of invasive pancreatic candidiasis, and therefore, the routine use of antimicrobial prophylaxis for SAP may be discouraged.

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KW - antimicrobial prophylaxis

KW - Candida

KW - fungal infection

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