Characteristics Of Severe Acute Pancreatitis With Fungal Infection In Mainland China

Objective: To summarize and analyze the clinical features of severe acute pancreatitis with fungal infection in mainland China,aiming to improve the early diagnosis and treatment of the disease and reduce the mortality of SAP with fungal infection.And to give patients who are SAP with fungal infections more suitable drugs.Methods: The "Acute pancreatitis" and " Mycoses” were searched for in the China Knowledge infrastructure,CNKI),VIP database,Wanfang database,PubMed,Cochrane library,EMBASE database.According to the proposed inclusion and exclusion criteria,we selected the literature published before March 2019,and selected the references included in the studies to avoid selection bias.Two investigators extracted the data.Related data of this disease were summarized,including basic information of the studies,the characteristics of the patients,the regional distribution of infected patients,the number of isolated fungi and the drug sensitivity of fungi.And then,the Excel was used for the extracted data,and the measurement data is represented by “x ± s”.And the count data is described by the composition ratio or “%”.Finally,we analyzed of gender,age,clinical characteristics,fungal distribution,fungal species and drug sensitivity in patients of SAP with fungal infections.Results: 32 studies were included and they were published from 2004 to 2018.We conclude that: 1.The proportion of male and female is about 1.39:1.The age is range 13 to 81 years old,with an average age of(48.53 ± 5.53)years.The hospitals are located in Shanghai(22%),Liaoning(13%),Beijing(12%),Xinjiang(11%),and Guangdong(7%),Guangxi(6%),Henan(6%)and others.2.The cause of SAP were different,such as biliary(50.97%),alcoholic(7.80%),hyperlipidemia(8.10%),overeating(14.09%),iatrogenic or traumatic(9.30%),others(9.74%).3.Samples Source: sputum(35.14%),urine(18.51%),necrotic tissue or pus around the pancreas or pancreas(15.11%),ascites(8.56%),blood(5.54%),bile(4.91%),feces(4.28%),deep vein catheter(3.53%),pleural fluid(2.65%),cerebrospinal fluid(1.39%),others(0.38%).4.Distribution of fungal: Candida albicans(58.71%),Candida tropicalis(19.07%),Candida glabrata(7.59%),Candida parapsilosis(4.92%),Filamentous bacteria(3.49%),Candida krusei(2.60%)and others(3.62%).5.Analysis of drug sensitivity: fluconazole(84.97%),amphotericin B(80.00%),voriconazole(78.56%),5-fluorocytosine(78.02%),Itraconazole(73.21%),ketoconazole(14.73%).The drug sensitivity of Candida albicans is: voriconazole(87.34%),amphotericin B(86.84%),5-Flucytosine(84.35%),fluconazole(79.79%),itraconazole(67.85%),and ketoconazole(10.71%).Conclusion: Studies have shown that SAP with fungal infections in mainland China is more common in men,mostly due to biliary pancreatitis.And the main site of infection is the lungs,the urinary tract and abdominal cavity.And we found the main strain is Candida albicans.Generally speaking,the drug sensitivity of different fungi is different,but the sensitivity is high.Thus,for those who are diagnosed as SAP with fungal infection,Fluconazole antifungal therapy can be used empirically before fungal culture results.