Pancreatic Infection in Severe Pancreatitis

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Abstract
SEVERE ACUTE pancreatitis is still a life-threatening disease. Most advances in the management of severe acute pancreatitis have arisen from general improvements in intensive care and organ system support.1,2 Septic complications occurring after the first 10 to 14 days of the disease are the most frequent cause of death in patients with pancreatic necrosis.3-5 Thus, infection of pancreatic or peripancreatic tissue is recognized as the single most important determinant of morbidity and mortality associated with severe necrotizing pancreatitis.4,6-8 During the natural course of acute pancreatitis, bacterial infection is reported to develop in 40% to 70% of all patients with necrotizing disease.9-11 Therefore, special interest has been focused on prophylactic administration of antibiotics, based on the hypothesis that reduction of late pancreatic infection will decrease morbidity and mortality. Early studies on prophylactic intravenous antibiotic treatment failed to show any favorable effect on the outcome of patients with acute pancreatitis, either because patients with mild disease were included or ineffective antibiotic regimens were used.12-14 On the other hand, recent controlled clinical studies support the use of early antibiotic treatment in patients with severe disease.15-19 A meta-analysis of these studies showed a positive benefit for antibiotics in reducing mortality when broad-spectrum antibiotics with proven pancreatic tissue penetration were used.20 Hence, routine early antibiotic treatment in all patients with necrotizing acute pancreatitis was recommended.21 However, widespread use of antibiotics may lead to an increased number of multiresistant bacterial and fungal infections, thereby worsening the course of the disease and the outcome. In this study, we report microbiological findings in patients who received prophylactic antibiotic treatment and analyze the influence of antibiotic treatment on the time point of infection, the type of organisms cultured from these patients, and the patient's outcome.