Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial1 ☆

Isenmann, Rainer; Rünzi, Michael; Kron, Martina; Kahl, Stefan; Kraus, Dietmar; Jung, Norbert; Maier, L.; Malfertheiner, Peter; Goebell, H.; Beger, H. G.

doi:10.1053/j.gastro.2003.12.050

Cited by 442 publications

(296 citation statements)

References 33 publications

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“…Although the use of prophylactic antibiotics to prevent infected pancreatic necrosis was once adopted eagerly based on a number of small, uncontrolled studies [5], subsequent randomized controlled trials could not find any advantage of this strategy [6,7]. This observation was upheld in the most recent meta-analyses [20,21] and the approach is no longer recommended by scientific societies [8].…”

Section: Discussionmentioning

confidence: 99%

“…Use of prophylactic antibiotics to prevent infection was advocated in the past, based largely on small, non-blinded studies. However, recent randomized controlled trials could not demonstrate any advantage of this tactic in patients with SAP [6,7]. But despite recommendations against the routine use of prophylaxis in this setting [8], many clinicians continue to administer antibiotics to patients without culture-proved infection [9][10][11].…”

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confidence: 99%

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Infections and Use of Antibiotics in Patients Admitted for Severe Acute Pancreatitis: Data from the EPIC II Study

Waele

Rello

Anzueto

et al. 2014

Surgical Infections

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Background: Infectious complications are frequent in severe acute pancreatitis (SAP) but multinational epidemiologic data are lacking. The aim of the study was to analyze the characteristics of the infectious complications and antimicrobial use in this setting. Methods: One-day point prevalence study of infection in critically ill patients (Extended Prevalence of Infection in the ICU-II study), performed in 1,265 ICUs in 75 countries. Results: Of the 13,796 patients in the study, 159 were admitted with SAP. One-hundred sixteen (73%) had infections: 31% intra-abdominal, 16% extra-abdominal, and 26% both. Gram-negative bacteria were more prevalent than gram-positive organisms, anaerobes, or fungi. Therapeutically, penicillins and other beta-lactams were used most frequently. Prophylactic antibiotics were administered to 24% of the patients with SAP. Conclusions: Infections are frequent in patients admitted with SAP; most are intra-abdominal infections. Microbiology is diverse with gram-negative micro-organisms most frequently isolated. Most patients admitted to the ICU for SAP receive antibiotics at some point.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Infections and Use of Antibiotics in Patients Admitted for Severe Acute Pancreatitis: Data from the EPIC II Study

Waele

Rello

Anzueto

et al. 2014

Surgical Infections

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“…[6][7][8] In 6 of 16 possible scenarios, mortality during 10 years' follow-up proved to be reduced, but only in 4 of 16 possible scenarios life-years were gained by prophylactic cholecystectomy, because surgical death occurs early, whereas gained lives occur later. Further data on incidence and subsequent mortality of pancreatitis (as well as other complications) in asymptomatic gallstone carriers are clearly needed, and further cost-benefit analyses with full-scale economic evaluations are required to determine total costs and potential benefits of prophylactic cholecystectomy versus "wait and see" strategy in the different scenarios.…”

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confidence: 99%

Intrahepatic cholestasis of pregnancy and bile acid levels

et al. 2005

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life-years than treatment according to "wait and see" strategy, depending on overall pancreatitis incidence (assumed to be 0.05%, 0.1%, 0.15%, or 0.2%/year) 3-5 and pancreatitis mortality (assumed to be 2.5%, 5%, 7.5%, or 10%). [6][7][8] In 6 of 16 possible scenarios, mortality during 10 years' follow-up proved to be reduced, but only in 4 of 16 possible scenarios life-years were gained by prophylactic cholecystectomy, because surgical death occurs early, whereas gained lives occur later. Further data on incidence and subsequent mortality of pancreatitis (as well as other complications) in asymptomatic gallstone carriers are clearly needed, and further cost-benefit analyses with full-scale economic evaluations are required to determine total costs and potential benefits of prophylactic cholecystectomy versus "wait and see" strategy in the different scenarios.NIELS G. VENNEMAN KAREL J. VAN Intrahepatic Cholestasis of Pregnancy and Bile Acid LevelsTo the Editor:We read with great interest the study reported by Glantz et al. 1 Although the authors should be congratulated on the data collected, we would nevertheless like to comment on their conclusions. Because these researchers had prospectively detected no increase of fetal risk in intrahepatic cholestasis of pregnancy (ICP) patients with bile acid levels less than 40 mol/L, they proposed to manage these women expectantly to reduce the costs of medical care. 1 We offer two reasons why this approach should be treated with caution.First, the pathogenesis of intrauterine fetal death (IUFD) in ICP remains unclear. 2 It has only been speculated, and never demonstrated, that bile acids may be the cause of IUFD in ICP. Moreover, it has never been demonstrated that they are solely responsible for IUFD in ICP and that other parameters do not play a role. 3 Second, among the three IUFDs that were reported by Glantz et al. during the observation period, one occurred while bile acid levels were less than 40 mol/L (27 mol/L). 1 Moreover, there was a slight increase in meconium staining of amniotic fluid, placenta, and membranes when bile acid levels were between 10 and 39 mol/L compared with normal controls. Although not statistically significant, these facts may be clinically significant.As the authors themselves report, "the low incidence of IUFD (0.4%) was due to increased attention devoted to ICP and its symptoms during the study which had led to high rates of induction of labor and planned cesarean section" (25% distributed as follows: 21% when bile acid levels were less than 10 mol/L, 24% when bile acid levels were between 10 and 39 mol/L, and 32% when bile acid levels were greater than 40 mol/L). 1 Therefore, why should obstetricians abandon active management, which is currently the only method that could reduce IUFD? 4 The policy of active management usefulness has been reinforced recently by the findings of Williamson et al. 5 These authors assessed the clinical outcome of 227 ICP patients. Among singleton pregnancies, 20 IUFDs were found. The median gestation...

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“…Interim analysis of 114 patients didn't show any benefit of prophylaxis with regards to decrease in the rate of infected pancreatic necrosis or systemic complications. But 28% of patients in study group received open antibiotic treatment (newly developed sepsis/SIRS/MSOF or suspicion of extrapancreatic/pancreatic infection) as compared to 46% in placebo group [23].…”

Section: Role Of Intravenous Antibioticsmentioning

confidence: 99%