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

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

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=13

YEAR=2023

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2023.1107326

DOI=10.3389/fcimb.2023.1107326

ISSN=2235-2988

ABSTRACT=<sec><title>Introduction</title><p>Infected pancreatic necrosis (IPN) is a severe complication of acute necrotizing pancreatitis with increasing morbidity. <italic>Escherichia coli</italic> is the most frequently cultured microorganism in IPN. However, the implications of <italic>Escherichia coli</italic> infection on the outcomes of patients with IPN remain unclear. Therefore, this study aimed to evaluate the clinical impacts of <italic>Escherichia coli</italic> infection on IPN.</p></sec><sec><title>Methods</title><p>A prospective database with consecutive patients with IPN between January 2010 and April 2022 at a tertiary hospital was <italic>post-hoc</italic> analyzed. The clinical and microbiological characteristics, surgical management, and follow-up data of patients with and without <italic>Escherichia coli</italic> infection were compared.</p></sec><sec><title>Results</title><p>A total of 294 IPN patients were enrolled in this cohort. Compared with non-<italic>Escherichia coli</italic> infection cases (n=80, 27.2%), patients with <italic>Escherichia coli</italic> infection (n=214, 72.8%) were characterized by more frequent polymicrobial infections (77.5% vs. 65.0%, <italic>P</italic>=0.04) but a lower occurrence of severe acute pancreatitis (SAP) (42.5% vs. 61.7%, <italic>P</italic>=0.003). In addition, significantly lower mortality (12.5% vs. 30.4%, <italic>p</italic>=0.002), fewer step-up surgical interventions (73.8% vs. 85.1%, <italic>P</italic>=0.025), and a lower rate of multiple organ failure (MOF) (25.0% vs. 40.2%, <italic>P</italic>=0.016) were also observed in patients with <italic>Escherichia coli</italic> infection. Multivariate analysis of mortality predictors indicated that MOF (odds ratio [OR], 6.197; 95% confidence interval [CI], 2.373–16.187; <italic>P</italic>&lt;0.001) and hemorrhage (OR, 3.485; 95% CI, 1.623–7.487; <italic>P</italic>=0.001) were independent predictors associated with higher mortality in patients with IPN. <italic>Escherichia coli</italic> infection was significantly associated with a lower mortality (OR, 0.302; 95% CI, 0.121–0.751; <italic>P</italic>= 0.01).</p></sec><sec><title>Conclusion</title><p><italic>Escherichia coli</italic> infection indicates a favorable prognosis in patients with IPN, although the mechanism needs further investigation.</p></sec>