Fr309 BREASTFEEDING IN PREVENTION OF POSTPARTUM ACUTE PANCREATITIS (AP). A POPULATION-BASED CASE-CONTROL STUDY

Introduction: Infected pancreatic necrosis (IPN) is associated with severe form of disease and poor outcomes.We evaluated necrotic collections for different organisms isolated and effect on clinical course.Methods: Prospective clinical observational study done in 62 patients undergoing drainage for symptomatic acute necrotic collection (ANC) and walled off necrosis (WON) of pancreas.The demographic characteristics, clinical and radiological parameters were noted.Blood cultures and necrotic fluid drained via endoscopic, percutaneous and surgical methods were sent for microbiological assessment.We correlated necrotic collection and blood culture positivity with outcomes.Results: 11 patients were females and 51 were males.Mean age was 36.8 ± 11.5 years.Most common etiology of acute necrotizing pancreatitis (ANP) was alcohol (53%).Fifty-six patients had organ failure (90%), amongst which, respiratory failure was most common (77.4%).Overall mortality rate was 23%.Forty-four patients had culture positive collections (70.9%).Infected necrotic collections were more likely to be associated with higher Modified CTSI (p=0.034),multiple organ failure (p= 0.019), longer ICU stay (p<0.001) and higher mortality (p=0.006) as compared to sterile collection.Mortality rate in polymicrobial necrotic cultures was 36.8% versus 28% in monomicrobial compared to 60% in polymicrobial blood cultures versus 33% in monomicrobial.However, the difference was not statistically significant.Commonest organisms isolated from necrotic collections were Escherichia coli (40.9%),Klebsiella pneumoniae (38.6%),Acinetobacter baumanii (22.7%) and Enterococcus sp.(15.9%).Blood cultures grew Staphylococcus sp.(43.4%) and Acinetobacter baumanii (26.08%) as the most common organisms.We noted that patients growing E. coli in necrotic collections had higher APACHE-II score at admission (p=0.030),more chances of cardiovascular failure (p=0.048) and higher mortality (p=0.017).E. coli isolated were most susceptible to amikacin (77.7%), colistimethate (72.2%) and imipenem (50%).Twenty-three patients had infected blood cultures (37.1%).Patients with positive blood cultures had longer ICU stay (p=0.001) and higher mortality (p=0.038).The presence of Acinetobacter in blood was associated with a longer ICU stay (p=0.032).Conclusion: The incidence of infection in symptomatic ANC and WON is around 70%. E. S-294 AGA Abstractscoli and Klebsiella pneumoniae were the commonest organisms isolated from necrotic collections.Blood culture was positive in 37%.Patients with culture positivity had adverse clinical course.Fr309