Clinical characteristics, microbiological spectrum and outcomes of early-onset extensive emphysematous pancreatitis

Abstract:

Background and Aims Early-onset extensive emphysematous pancreatitis (EP) is a rare but highly lethal subtype of infected pancreatic necrosis (IPN), characterized by abrupt onset and rapid deterioration. This study aimed to investigate its clinical characteristics, microbiological spectrum, treatment approaches, and outcomes to provide evidence for early identification and timely intervention.Methods A retrospective analysis was performed on 305 IPN patients treated at Xiangya Hospital, Central South University, from January 2010 to October 2023. Eight patients who developed gas accumulation involving ≥50% of pancreatic or peripancreatic necrosis within two weeks of onset were defined as early-onset extensive EP. Their clinical data were compared with those of ordinary IPN patients.Results Early-onset extensive EP accounted for 2.6% of all IPN cases. The early-onset extensive EP group had significantly higher mortality and multiple organ failure rates compared with the ordinary IPN group (75.0% vs. 24.6% and 75.0% vs. 34.7%, respectively; both P<0.05). A total of 15 microbial isolates were identified from early-onset extensive EP patients, predominantly Klebsiella pneumoniae (62.5%) and Escherichia coli (37.5%). The infection rate of carbapenem-resistant Enterobacteriaceae (CRE) was markedly higher in the EP group than in the ordinary IPN group (75.0% vs. 31.1%, P=0.015). Most patients were treated using a step-up approach based on percutaneous catheter drainage, with no significant difference in treatment strategy between the two groups (P=0.625).Conclusion Early-onset extensive EP represents a rare and fulminant subtype of IPN with extremely poor outcomes. Klebsiella pneumoniae and CRE are the predominant pathogens. Early radiological evaluation and timely intervention are crucial for improving prognosis in these patients.