Diagnosis of Infected Pancreatic Necrosis

Bassi, Claudio; Falconi, Massimo; Bonora, Antonio; Sartori, Nora; Caldiron, E.; Salvia, Roberto; Girelli, R.; Pederzoli, Paolo

doi:10.1007/978-3-642-60580-2_6

Cited by 10 publications

(20 citation statements)

References 18 publications

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“…Recent data shows overall mortality from mild and severe acute pancreatitis in the range of 15%. However, infection of pancreatic necrosis worsens the prognosis and triples the mortality rate [21][22][23]. We observed the typical biphasic mode in our SAP patients, with SIRS manifesting during the first 2 weeks and infectious complications developing from 3rd-4th week after onset of the disease.…”

Section: Discussionmentioning

confidence: 72%

Factors Influencing the Development of Nosocomial Pancreatic Infection in Severe Acute Pancreatitis

Dambrauskas¹,

Gulbinas²,

Vanagas³

et al. 2007

Visc Med

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Infectious complications account for approximately 80% of deaths in severe acute necrotizing pancreatitis. The objective of our study was to determine the role of invasive procedures for the development of infected pancreas necrosis with bacteria resistant to firstline antibiotics. Patients and Methods: For the present investigation, a prospective, nonrandomized study design was used. The study population consisted of 47 consecutive patients with severe necrotizing pancreatitis. Data related to infectious complications was collected, and statistical analysis was performed to reveal factors influencing the occurrence of infected necrosis induced by bacteria resistant to first-line antibiotics. Results: Our study showed a biphasic mode of the disease, with infectious complications manifesting on the 3rd-4th week after onset of pancreatitis. Statistical analysis revealed that early fine needle aspiration (FNA) of pancreatic necrosis (days 8-14 of disease) and prolonged duration of central venous (CV) catheterization were independent risk factors for development of infected necrosis induced by bacteria resistant to first-line antibiotics, but the latter had an even stronger relationship to the occurrence of generalized septicemia. Conclusion: FNA of pancreatic necrosis during the first 2 weeks after onset of acute pancreatitis is a risk factor for development of infected necrosis induced by bacteria resistant to first-line antibiotics. Ultrasound-guided aspirations should only be performed in patients with signs of sepsis.

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Section: Discussionmentioning

confidence: 72%

Factors Influencing the Development of Nosocomial Pancreatic Infection in Severe Acute Pancreatitis

Dambrauskas¹,

Gulbinas²,

Vanagas³

et al. 2007

Visc Med

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“…Pancreatic infection basically occurs in patients with pancreatic or peripancreatic necrosis and/ or fluid collections. Pancreatic necrosis become infected in a percentage ranging from 20 to 70% and, as a rule, a time dependent increase of the infection rate with the duration of the disease is registered [4][5][6][7] (Figure 1). The late course of necrotizing pancreatitis is determined by bacterial infection of pancreatic and peripancreatic necrosis.…”

Section: Review Articlementioning

confidence: 91%

“…All patients with these features received treatment with antibiotics. Other multicentric, double blind, randomized trial comparing meronem and placebo showed no statistically significant difference between the treatment groups for pancreatic or peripancreatic infection, mortality or requirement for surgical intervention, and did not support early prophylactic antimicrobial use in patients with severe acute necrotizing pancreatitis [37] (Table 5) [4,18,32,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56].…”

Section: Antibiotic Prophylaxismentioning

confidence: 99%

Antibiotics in severe acute pancreatitis

Serrablo

Tejedor²,

Martínez

2014

Open Medicine

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AbstractAcute pancreatitis (AP) is a local inflammatory response with systemic effects and an adverse evolution in 20% of cases. Its mortality rate is 5–10% in sterile and 15–40% in infected pancreatic necrosis. Infection is widely accepted as the main reason of death in AP. The evidence to enable a recommendation about antibiotic prophylaxis against infection of pancreatic necrosis is conflicting and difficult to interpret. Up to date, there is no evidence that supports the routine use of antibiotic prophylaxis in patients with severe AP. Treatment on demand seems to be the better option, avoiding excessive treatment and selection of bacterial. In infected acute pancreatitis, antibiotics of choice are imipenem, meronem or tigecycline in patients allergic to beta-lactams. Also fluconazole must be given in determinate clinical situations.

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“…Furthermore, the patients are not substratified on the basis of extent of necrosis, that is recognized as being the main risk factor for the development of sepsis [1]. Finally, two-thirds of the patients under treatment changed the original antibiotic regimen within a mean period of 9 days.…”

Section: Clinical Trialsmentioning

confidence: 99%

“…In severe pancreatitis the mortality rate is as high as 40% if pancreatic necrosis developed with infection [1]. Early diagnosis, treatment and, whenever possible, pre- vention of infections have become relevant endpoints of severe pancreatitis management.…”

Section: Introductionmentioning

confidence: 99%

Infections in Pancreatic Inflammatory Disease: Clinical Trials for Antibiotic Prophylaxis

Bassi¹

2001

Pancreatology

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Diagnosis of Infected Pancreatic Necrosis

Cited by 10 publications

References 18 publications

Factors Influencing the Development of Nosocomial Pancreatic Infection in Severe Acute Pancreatitis

Factors Influencing the Development of Nosocomial Pancreatic Infection in Severe Acute Pancreatitis

Antibiotics in severe acute pancreatitis

Infections in Pancreatic Inflammatory Disease: Clinical Trials for Antibiotic Prophylaxis

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