Localized and systemic bacterial infections in necrotizing pancreatitis submitted to surgical necrosectomy or percutaneous drainage of necrotic secretions

Abstract

BackgroundInfectious complications are observed in 40-70% of all patients with severe acute pancreatitis. Infections are associated with a significant increase in mortality rates.MethodsWe evaluated the prevalence and characteristics of pancreatic and systemic infections in 46 patients with necrotizing pancreatitis submitted to surgical procedures during their hospital stay as well as the impact of such infectious complications on patient clinical outcome. Samples for microbiological cultures were taken at hospital admission from blood and bile and 2 days after invasive procedure from blood, drainage fluid, bile and necrotic tissues.Results74% patients with necrotizing pancreatitis had a localized or systemic infection. At admission, 15% of subjects had positive blood cultures whereas 13% had evidence of bacterial growth from bile cultures. Two days after the invasive procedures for removal of necrotic materials and fluids, blood cultures became positive in 30% of patients in spite of antibiotic prophylaxis and bile cultures resulted positive in 22% of cases. Furthermore, bacterial growth from drainage fluids was found in 30% and from homogenized necrotic material in 44% of cases. As refers to bacterial isolates, all patients had a monomicrobial infection. Carbapenems were the drugs with the best sensitivity profile.Mortality rate was significantly (p < 0.05) higher among patients with infection (17%) than subjects without infection (8%). Within the infected group, those subjects with evidence of systemic infection (positive blood cultures) developed more complications and demonstrated a higher (p < 0.05) mortality rate (28%) than those who had only a localized infection (10%).ConclusionsInfectious complications significantly increase mortality in patients with necrotizing pancreatitis. In addition, subjects with systemic infections developed more complications and demonstrated a higher mortality rate in comparison with those having a localized infection. In our study, the sensitivity pattern of the isolated microorganisms suggests to consider carbapenems as the best option for empirical treatment in patients with necrotizing pancreatitis who develop a clear-cut evidence of systemic or localized bacterial infection.

Anorectal mucosal melanoma

“…WLE has minimal morbidity and no compromise local function, preserve the anal sphincter. APR is often associated with high morbidity rate and functional compromise [ 82 – 84 ]. The small number of studies shows no significant differences in survival between patients treated with APR and WLE [ 85 ].…”

How severe is moderately severe acute pancreatitis? Clinical validation of revised 2012 Atlanta Classification

“…The updated Atlanta 2012 classification addresses this missing group and “moderately severe” category is introduced[ 9 , 10 ]. While performing analysis of our clinical database, patients who had less than 48 hours transitory one organ system failure and previously categorized as “severe” pancreatitis (“moderately severe” according to Atlanta 2012), usually had self-limited disease, little risk of local and systemic complications, and the course of AP was like “mild” AP[ 2 , 3 , 14 - 18 ]. As a result, these patients require shorter ICU stay if any at all, less frequently develop infected pancreatic necrosis and/or sepsis, furthermore, require little or no US guided or surgical interventions.…”

Symptom Severity Following Rifaximin and the Probiotic VSL#3 in Patients with Chronic Pelvic Pain Syndrome (Due to Inflammatory Prostatitis) Plus Irritable Bowel Syndrome

“…Inclusion criteria of patients and the control group were, respectively, diagnosis of CP/CPSS plus D-IBS and IBS alone. Exclusion criteria were as follows: (1) history of chronic bacterial prostatitis (NIH type II) with a positive bacteriological finding at spermculture or at the Meares-Stamey four-glass test [ 22 ]; (2) subjects suffering from chronic or acute illness that could interfere with the study, who were taking medications that could interfere in the study (including anti-inflammatory drugs, proton pump inhibitors (PPIs), antidepressants, anti-diarrhoeal, prokinetics, and antispasmodic agents), and who consumed antibiotics or probiotics in the four weeks prior to entering the study; (3) obesity (defined as a body mass index (BMI) greater than or equal to 30 kg/m 2 ); (4) subjects affected by major concomitant diseases, with known anatomical abnormalities of the urinary tract or with evidence of other urological diseases, and with residual urine volume >50 mL resulting from bladder outlet obstruction; (5) patients with a history of gastrointestinal bleeding or duodenal or gastric ulcers [ 23 ]; and (6) patients that use VSL3 or other probiotic formulations, herbal medicines, or prostatitis treatments [ 24 , 25 , 26 , 27 , 28 ].…”