Prevention of Infectious Complications in Acute Pancreatitis

Poropat, Goran; Radovan, Anja; Perić, Marija; Mikolašević, Ivana; Giljača, Vanja; Hauser, Goran; Milić, Sandra; Štimac, Davor

doi:10.1097/mpa.0000000000001368

Cited by 13 publications

(3 citation statements)

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“…The start of big randomized, double-blind, placebo-controlled trials on the other hand, i.e., Refs. [13][14][15][16][17], has not confirmed the previously recognized benefit of antibiotic therapy. Renewed evidence from randomized clinical trials (RCTs) has been confirmed by recent systematic reviews [18][19][20][21][22], and antimicrobials are currently recommended only when infection is either proven or strongly suspected [23].…”

Section: Introductionmentioning

confidence: 82%

Antibiotic Utilization in Acute Pancreatitis: A Narrative Review

et al. 2023

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Acute pancreatitis is a complex inflammatory disease with significant morbidity and mortality. Despite advances in its management, the role of antibiotics in the prophylaxis and treatment of acute pancreatitis remains controversial. The aim of this comprehensive review is to analyze current evidence on the use of antibiotics in acute pancreatitis, focusing on prophylactic and therapeutic strategies. Prophylactic use aims to prevent local and systemic infections. However, recent studies have questioned the routine use of antibiotics for prophylaxis and highlighted the potential risks of antibiotic resistance and adverse effects. In selected high-risk cases, such as infected necrotizing pancreatitis, prophylactic antibiotic therapy may still be beneficial. As for therapeutic use, antibiotics are usually used to treat infected pancreatic necrosis and extrapancreatic infections. When selecting an antibiotic, the microbiologic profile and local resistance patterns should be considered. Combination therapy with broad-spectrum antibiotics is often recommended to cover both Gram-positive and Gram-negative pathogens. Recent research has highlighted the importance of individualized approaches to antibiotic use in acute pancreatitis and underscored the need for a tailored approach based on patient-specific factors. This review also highlights the potential role of new antimicrobial agents and alternative strategies, such as probiotics, in the management of acute pancreatitis.

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Section: Introductionmentioning

confidence: 82%

Antibiotic Utilization in Acute Pancreatitis: A Narrative Review

et al. 2023

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“…However, despite the advantages of carbapenems' pharmacokinetic/pharmacodynamic (pk/pd) in pancreatic tissue, the effect of their prophylactic use on necrotic tissue infection and pancreatitis-related outcomes, such as mortality, is still uncertain. Particularly, high-quality randomized controlled trials with a low risk of bias have detected no relationship between prophylactic carbapenem use and pancreatitis-related outcomes ( 7 , 8 ). However, some observational studies have detected a reduction in infection risk through the use of prophylactic carbapenems, leading them to be used frequently in daily practice ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Prophylactic Carbapenem Use on Outcomes in Acute Pancreatitis: A Systematic Review and Meta-Analysis

Buyukkoruk,

Senturk,

Ozger

2023

Infect Dis Clin Microbiol

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Objective: This study aimed to determine the effect of prophylactic use of carbapenems for acute pancreatitis on clinical outcomes. Materials and Methods: It was conducted according to the preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using the keywords “Pancrea* AND carbapenem OR imipenem OR ertapenem OR meropenem OR doripenem.” Primer outcomes were mortality, surgical intervention, and pancreatic and non-pancreatic infection. Subgroup analyses were also performed to reduce the risk of bias. Results: Ten studies with 4038 patients were included in the meta-analyses. While eight of ten were randomized controlled trials, two were observational studies. The prophylactic use of carbapenems had no statistically significant effect on mortality (OR=0.82, 95% CI=0.65-1.04, I²=0%) and surgical intervention. (OR=0.81, 95% CI=0.57-1.17, I²=0%). However, the real impact of prophylaxis on reducing the incidence of mortality and surgical intervention was uncertain due to the insufficient sample size. The prophylactic use of carbapenems was significantly associated with a lower risk of peripancreatic (OR=0.37, 95% CI=0.25-0.55, I²=61%) and non-pancreatic infection risk (OR=0.60, 95% CI=0.46-0.78, I²=65%). The definitions of infection in the articles were not clear, and the diagnostic approach to infection was based on subjective criteria. In addition, there was inadequate collateral damage and safety assessments. In high-quality studies with a low risk of bias, prophylactic carbapenems had no effect on peripancreatic infection (RR=1.54, 95% CI=0.65-3.47, I²=0%) and non-pancreatic infection (RR=0.72, 95% CI=0.48-1.07, I²=0%). Conclusion: Although there is a reduction in the infection risk, routine carbapenem use in acute pancreatitis cases should not be recommended based on current evidence. Cooperation with Infectious Disease specialists and developing diagnostic algorithms are required instead of routine prophylaxis to prevent infection, especially non-pancreatic infection. Keywords: acute pancreatitis, necrotizing pancreatitis, carbapenem, prophylaxis, systematic review, meta-analysis

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“…Infectious complications are a significant concern in the management of AP, as the control of infection can have a significant impact on patient outcomes [ 7 – 10 ]. To ensure the best possible outcome for patients, it is crucial to make an early and accurate diagnosis of infectious pancreatic necrosis.…”

Section: Introductionmentioning

confidence: 99%

Effect of early antibiotic treatment strategy on prognosis of acute pancreatitis

Wen,

Xu,

Zhang

et al. 2023

BMC Gastroenterol

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Background Antibiotic use in the early stages of acute pancreatitis is controversial. The purpose of this study was to investigate the effect of early antibiotic application on the prognosis of acute pancreatitis (AP). Materials and methods Clinical data of patients with primary AP admitted to our emergency ward within 72 hours of onset were retrospectively collected from January 2016 to December 2020. We classified patients with acute pancreatitis according to etiology and disease severity, and compared the differences in hospital stay, laparotomy rate, and in-hospital mortality among AP patients who received different antibiotic treatment strategies within 72 hours of onset. Results A total of 1134 cases were included, with 681 (60.1%) receiving early antibiotic treatment and 453 (39.9%) not receiving it. There were no significant differences in baseline values and outcomes between the two groups. In subgroup analysis, patients with biliary severe acute pancreatitis (SAP) who received early antibiotics had lower rates of laparotomy and invasive mechanical ventilation, as well as shorter hospital stays compared to those who did not receive antibiotics. In logistic regression analysis, the early administration of carbapenem antibiotics in biliary SAP patients was associated with a lower in-hospital mortality rate. Early antibiotic use in biliary moderate-severe acute pancreatitis (MSAP) reduced hospital stays and in-hospital mortality. Quinolone combined with metronidazole treatment in biliary mild acute pancreatitis (MAP) shortened hospital stays. Early antibiotic use does not benefit patients with non-biliary AP. Conclusion Strategies for antibiotic use in the early stages of AP need to be stratified according to cause and disease severity.

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Prevention of Infectious Complications in Acute Pancreatitis

Cited by 13 publications

References 13 publications

Antibiotic Utilization in Acute Pancreatitis: A Narrative Review

Antibiotic Utilization in Acute Pancreatitis: A Narrative Review

The Effect of Prophylactic Carbapenem Use on Outcomes in Acute Pancreatitis: A Systematic Review and Meta-Analysis

Effect of early antibiotic treatment strategy on prognosis of acute pancreatitis

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