Antibiotic therapy in acute pancreatitis: From global overuse to evidence based recommendations

Párniczky, Andrea; Lantos, Tamás; Tóth, É.; Szakács, Zsolt; Gódi, Szilárd; Hágendorn, Roland; Illés, Dóra; Koncz, Balázs; Korbonits, M; Mikó, Alexandra; Mosztbacher, Dóra; Németh, Balázs Csaba; Pécsi, Dániel; Szabó, Anikó; Szücs, Ákos; Varjú, Péter; Szentesi, Andrea; Darvasi, Erika; Erőss, Bálint; Izbéki, Ferenc; Gajdán, László; Halász, Adrienn; Vincze, Áron; Szabó, Imre; Pár, Gabriella; Bajor, Judit; Patrícia, Silvia; Czimmer, József; Hamvas, József; Takács, Tamás; Szepes, Zoltán; Czakó, László; Varga, Márta; Novák, Jan; Bod, Barnabás; Szepes, Attila; Sümegi, János; Papp, Mária; Góg, Csaba; Török, Imola; Huang, Wei; Xia, Qing; Xue, Ping; Li, Weiqin; Chen, Weiwei; Shirinskaya, N. V.; Полуэктов, В Л; Shirinskaya, A.V.; Hegyi, Péter; Bátovský, M; Rodríguez-Oballe, Juan A.; Salas, I. Miguel; López-Díaz, Javier; Domínguez‐Muñoz, Enrique; Molero, Xavier; Pando, Elizabeth; Ruiz-Rebollo, María Lourdes; Burgueño-Gómez, Beatriz; Yt, Chang; Chang, Ming-Huang; Sud, Ajay; Moore, Danielle; Sutton, Robert; Gougol, Amir; Papachristou, Georgios I.; Susak, Yaroslav; Tiuliukin, Illia Olehovych; Gomes, António; Oliveira, Maria Jesus; Aparício, David; Tanţău, Marcel; Kurti, Floreta; Kovacheva-Slavova, Mila; Stecher, Stephanie-Susanne; Mayerle, Julia; Poropat, Goran; Das, Kshaunish; Marino, Marco Vito; Capurso, Gabriele; Małecka‐Panas, Ewa; Zatorski, Hubert; Gąsiorowska, Anita; Fabisiak, Natalia; Ceranowicz, Piotr; Kuśnierz-Cabała, Beata; Carvalho, Joana Rita; Fernandes, Samuel; Chang, Jae Hyuck; Choi, Eun Kwang; Han, Jimin; Bertilsson, Sara; Jumaa, Hanaz; Sandblom, Gabriel; Kaçar, Sabite; Baltatzis, Minas; Varabei, Aliaksandr; Yeshy, Vizhynis; Chooklin, S.; Kozachenko, A.; Veligotsky, Nikolay

doi:10.1016/j.pan.2019.04.003

Cited by 78 publications

(39 citation statements)

References 61 publications

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“…However, CRP levels are influenced by liver disease [127], which may be present in many patients with AP who are obese and/or alcoholics. Despite its high applicability in clinical practice, this inflammatory marker has disadvantages, such as its late peak (48 to 72 h), its nonspeficitity as an inflammatory marker of the pancreas, and its levels are not associated with the infection [128]. Due to their non-specificity, other inflammatory conditions may influence its increase.…”

Section: C-reactive Proteinmentioning

confidence: 99%

“…Hagjer et al [36], in their prospective observational study, concluded that PCT was a promising inflammatory marker with prediction rates similar to the BISAP score. Studies showed that PCT is the most sensitive laboratory test for the detection of pancreatic infection, and low levels appear to be strong negative predictors of infected necrosis [128]. The role of this marker as a tool to identify which patients need antibiotics as well as the duration of the treatment is under study [135].…”

Section: Procalcitoninmentioning

confidence: 99%

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Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice

Silva-Vaz

Abrantes

Castelo‐Branco

et al. 2020

IJMS

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Acute pancreatitis (AP) is a severe inflammation of the pancreas presented with sudden onset and severe abdominal pain with a high morbidity and mortality rate, if accompanied by severe local and systemic complications. Numerous studies have been published about the pathogenesis of AP; however, the precise mechanism behind this pathology remains unclear. Extensive research conducted over the last decades has demonstrated that the first 24 h after symptom onset are critical for the identification of patients who are at risk of developing complications or death. The identification of these subgroups of patients is crucial in order to start an aggressive approach to prevent mortality. In this sense and to avoid unnecessary overtreatment, thereby reducing the financial implications, the proper identification of mild disease is also important and necessary. A large number of multifactorial scoring systems and biochemical markers are described to predict the severity. Despite recent progress in understanding the pathophysiology of AP, more research is needed to enable a faster and more accurate prediction of severe AP. This review provides an overview of the available multifactorial scoring systems and biochemical markers for predicting severe AP with a special focus on their advantages and limitations.

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Section: C-reactive Proteinmentioning

confidence: 99%

Section: Procalcitoninmentioning

confidence: 99%

Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice

Silva-Vaz

Abrantes

Castelo‐Branco

et al. 2020

IJMS

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show abstract

“…Patient data were collected from registry establishment until 31 December 2019 on electronic case report forms and validated using a four-tiered data validation protocol. Contributing centers are shown in the supplementary material 20 . The Hungarian Pancreatic Study Group published analyses from the registry, the population of which may overlap with our analyzed cohort [20][21][22][23][24][25][26][27][28][29][30] .…”

Section: Study Design and De Nitionsmentioning

confidence: 99%

Hypoalbuminemia, An Independent Risk Factor for Severity and Mortality Affects One Third of Patients in Acute Pancreatitis: Multicenter Prospective International Cohort Analysis

Ocskay¹,

Vinkó²,

Németh³

et al. 2021

Preprint

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Introduction The incidence and medical costs of acute pancreatitis (AP) are on the rise, and severe cases still have a 30% mortality rate. We aimed to evaluate hypoalbuminemia as a risk factor and the prognostic value of human serum albumin in AP. Methods Data of 2461 patients were extracted from the international, prospective, multicenter AP registry of the Hungarian Pancreatic Study Group. Data of patients with albumin measurement in the first 48 hours (n=1149) and anytime during hospitalization (n=1272) was analyzed. Multivariate binary logistic regression and Receiver Operator Characteristic curve analysis were used. Results The prevalence of hypoalbuminemia (<35g/L) was 19% on-admission and 35.7% during hospitalization. Hypoalbuminemia dose-dependently increased the risk of severity, mortality, local complications, and organ failure and is associated with longer hospital stay. The predictive value of hypoalbuminemia on-admission was poor for severity and mortality. Severe hypoalbuminemia (<25 g/L) was an independent risk factor for severity (OR: 48.761; CI:25.276-98.908) and mortality (OR:16.83; CI: 8.32-35.13). Albumin loss during AP was strongly associated with severity (p<0.001) and mortality (p=0.002).Conclusion Hypoalbuminemia is an independent risk factor of severity and mortality in AP, and it shows a dose-dependent relationship with local complications, organ failure, and length of stay.

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“…In 25 % der Fälle war die Verordnung nicht indiziert, und bei 18 % fand sich keine Angabe einer Indikation [28]. Auch bei gastroenterologischen Erkrankungen wie Gastroenteritis [29] oder akuter Pankreatitis erfolgen zu häufig Antibiotikagaben [6,30]. Insbesondere bei letzterer Diagnose sollte auf eine prophylaktische Gabe verzichtet werden [6].…”

Section: Kee Zum Einsatz Von Antibiotikaunclassified

Klug entscheiden – Perspektiven: Was sind die entscheidenden Ansätze (Key Questions) für die Zukunft?

Holstege¹

2020

Z Gastroenterol

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ZusammenfassungDie Gastroenterologie bietet ein weites Feld für zukünftige „Klug-entscheiden-Empfehlungen“ (KEE), die nicht nur den gesicherten Einsatz diagnostischer Tests wie Laboruntersuchungen oder bildgebende Verfahren betreffen, sondern auch medikamentöse Therapien und die gastroenterologische Endoskopie. Dem zu häufigen Einsatz von Medikamenten wie Antibiotika und Protonenpumpenhemmern steht ihr zu seltener Einsatz bei gesicherten Indikationen gegenüber. Ähnliches trifft auf die abdominelle Bildgebung zu, insofern bei vielen Fragestellungen zu häufig der Computertomografie der Vorzug vor einer qualifizierten Sonografie gegeben wird. Laborwerte wie Lipase oder Amylase sind beim asymptomatischen Patienten nicht weiterführend und verursachen u. U. eine Vielzahl von unnötigen weiteren diagnostischen Maßnahmen. Bei akuter Pankreatitis bringt die Bestimmung beider Enzyme keinen additiven diagnostischen Nutzen. Ähnlich wenig hilfreich ist der unkritische Einsatz von weiteren für die Gastroenterologie relevanten Laborparametern wie CEA, Ammoniak oder Procalcitonin. In der Endoskopie ist eine „Vorsorgegastroskopie“ bei asymptomatischen Patienten ohne Risikofaktoren nicht sinnvoll, während die Koloskopie als Vorsorgeuntersuchung auf ein Kolonkarzinom zu selten von über 50-Jährigen wahrgenommen wird.Die sich dramatisch entwickelnde Adipositaspandemie und der damit einhergehende massive Anstieg an fortgeschrittenen nichtalkoholischen Fettlebererkrankungen mit entsprechender Morbidität und Mortalität machen KEE erforderlich, die nicht nur Empfehlungen für den einzelnen Patienten geben, sondern auch Maßnahmen zur Regulierung des Verkaufs hochverarbeiteter Lebensmittel oder zuckerreicher Softdrinks darlegen. Auch zukünftig werden sich die „Key Questions“ für KEE in der Gastroenterologie aus der Erstellung von Leitlinien heraus ergeben. Dennoch sind auch KEE für Situationen im klinischen Alltag wünschenswert, für die es keine Leitlinienempfehlungen gibt. Durch interdisziplinären Expertenkonsens und Berücksichtigung vorhandener wissenschaftlicher Daten kann diesen KEE eine sichere Basis verschafft werden.

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Antibiotic therapy in acute pancreatitis: From global overuse to evidence based recommendations

Cited by 78 publications

References 61 publications

Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice

Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice

Hypoalbuminemia, An Independent Risk Factor for Severity and Mortality Affects One Third of Patients in Acute Pancreatitis: Multicenter Prospective International Cohort Analysis

Klug entscheiden – Perspektiven: Was sind die entscheidenden Ansätze (Key Questions) für die Zukunft?

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