Prevention of bacterial infection and sepsis in acute severe pancreatitis.
Between 1984 and 1986 six patients with acute respiratory failure (requiring ventilation for at least 3 days) complicating acute pancreatitis were managed on the intensive care unit (median ventilation period 6 days; range 3-41 days). Between 1987 and 1989 nine similar patients were managed (median ventilation period 35 days, range 4-69 days), and a regimen of enteral tobramycin, polymyxin and amphotericin to selectively decontaminate the digestive tract (SDD) was introduced. Five of six patients treated before 1987 had serious infections (three Gram-negative, one fungal), compared with only one of nine patients treated with SDD (P < 0.05). Clinical signs of sepsis were evident for 62% of the pre-SDD period, compared with 39% of the period during SDD therapy (P < 0.001). Systemic antibiotic prescribing was reduced in the SDD group; however, mortality remained unaffected with only two patients surviving pre-SDD and three during SDD treatment. SDD reduces infection rates and sepsis in patients with acute pancreatitis and may help to improve the prognosis of this life-threatening condition.
McClelland
P
P
Renal Unit, Royal Liverpool Hospital.
Murray
A
A
Yaqoob
M
M
Van Saene
H K
HK
Bone
J M
JM
Mostafa
S M
SM
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D016470:Bacteremia / Q000517:prevention & control; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications*; D011113:Polymyxins / Q000627:therapeutic use*; D014031:Tobramycin / Q000627:therapeutic use*
D011113:Polymyxins; D000666:Amphotericin B; D014031:Tobramycin