Background: Infected pancreatic necrosis (IPN) is a serious complication of moderate-to-severe acute pancreatitis (AP), associated with high morbidity, intensive care unit (ICU) admission, organ failure, and mortality. Initial management relies on antibiotics and drainage of walled-off necrosis (WON). In the context of increasing multidrug-resistant (MDR) bacteria, identifying risk factors for MDR emergence is crucial. The impact of fungal infections (FIs) on outcomes also remains unclear. This study aimed to identify risk factors associated with the emergence of MDR bacteria and FIs during intervention for IPN. Methods: This retrospective study included 71 consecutive patients undergoing intervention for suspected IPN or symptomatic WON. Results: At first intervention, IPN was confirmed in 52 patients (73%), MDR bacteria in 19 (27%), extensively drug-resistant (XDR) bacteria in 4 (5.6%), and FI in 21 (30%). After all interventions, MDR/XDR bacteria and fungi were detected in 25 (35%)/11 (15.5%) and 42 (59%) patients, respectively. Independent risk factors for MDR emergence were the number of antibiotic changes (b, 1.70; 95% CI 1.18–2.43; p = 0.004) and need for nutritional support (NS) (b, 5.69; 95% CI 1.52–20.50; p = 0.010). No independent factor was associated with FI. The 180-day mortality did not differ across groups. The 90-day cumulative ICU admission rate was higher in IPN vs. non-IPN (63.1% vs. 29.4%, p = 0.030) and in MDR vs. non-MDR (72.2% vs. 37.1%, p = 0.005). Conclusions: Antibiotic changes and NS were independently associated with MDR emergence in IPN. No independent factors were linked to FI. ICU admission was significantly higher in IPN and MDR cases.

Background and Objective Obstructive sleep apnea (OSA) is a multifactorial disease, and obesity is the most prevalent risk factor for OSA. Endoscopic sleeve gastroplasty (ESG) is a minimally-invasive procedure used for treating obesity. This prospective study tested the potential benefit of weight loss via an ESG device, endomina®, for reduction of apnea-hypopnea index (AHI) in patients with class I obesity and severe OSA.Methods Ten patients with BMI values of 28 to 34.9 kg/m2 and severe OSA underwent ESG and lifestyle management for 6 months. Patients underwent polysomnography before and 6 months after the endoscopic procedure. The primary endpoint was the percentage of AHI reduction six months after the endoscopic procedure. Secondary endpoints were the proportion of patients with AHI reductions of 50% six months after ESG, improvements in respiratory parameters and sleepiness, effectiveness on weight loss, and correlations with decreased AHI.Results Patients experienced 54% (±11%) reductions in AHI. Seven patients had an AHI reduction of ≥50%, and five had an AHI of <15 events/h. Total body weight loss (TBWL) and excess weight loss (EWL) were 10.1% (±3.4%) and 45.4% (±14.0%), respectively, and there was no correlation between AHI and TBWL/EWL. There was an overall improvement in respiratory sleep parameters after ESG, except for snoring, and a reduction in daytime sleepiness.Conclusions These results suggest that using an ESG device, endomina®, with lifestyle modification for promoting weight loss in class I obese patients with severe OSA is a promising treatment strategy for reducing OSA and improving respiratory parameters and daytime sleepiness.