Clinical outcomes and risk factors of invasive candidiasis in patients with infected pancreatic necrosis.

Abstract

Background: Invasive candidiasis in patients with infected pancreatic necrosis (IPN) can lead to severe morbidity and mortality. However, there is still limited information regarding clinical characteristics, antifungal efficacy and prognosis of these patients.

Purpose: This study aimed to identify factors associated with antifungal therapy failure and mortality in IPN patients complicated by invasive candidiasis.

Methods: This single-center, retrospective study included IPN patients admitted between January 2022 and April 2024 who were diagnosed with invasive candidiasis, defined as either candidemia or localized pancreatic fungal infection confirmed by a positive Candida culture from an aseptically collected pancreatic or peripancreatic necrotic tissue specimen. The primary outcomes were the efficacy of antifungal therapy at day 7 and at the end of intravenous treatment, as well as 28-day all-cause mortality. Logistic regression analysis was employed to identify risk factors associated with antifungal therapy failure or mortality.

Results: Among 815 IPN patients, 114 (14.0 %) developed invasive candidiasis. Of these, 60.5 % had candidemia with or without pancreatic fungal infection, and 39.5 % had isolated pancreatic fungal infection. Antifungal therapy was effective in 38.6 % of patients at day 7 and in 63.2 % at the end of intravenous treatment. The 28-day all-cause mortality rate was 12.9 %. Logistic regression analysis demonstrated that breakthrough fungal infection was significantly associated with antifungal therapy failure at day 7 (OR 2.906, 95 % CI 1.232-6.858, p = 0.015). Septic shock at the time of first positive culture (OR 5.416, 95 % CI 2.006-14.623, p = 0.001) and isolated pancreatic fungal infection (OR 3.090, 95 % CI 1.106-8.630, p = 0.031) were significantly associated with antifungal therapy failure at the end of intravenous treatment. Multiple organ dysfunction syndrome was identified as an independent risk factor for 28-day mortality (OR 21.224, 95 % CI 2.550-176.627, p = 0.005).

Conclusion: IPN Patients complicated by invasive candidiasis exhibited a relatively low overall response to antifungal therapy. Breakthrough fungal infection was identified as an independent risk factor for early therapy failure, while septic shock and isolated pancreatic fungal infection were significantly associated with therapy failure at the end of intravenous therapy. Multiple organ dysfunction syndrome was an independent predictor of 28-day mortality.