Antibiotic prophylaxis of pancreatic infection in patients with necrotizing pancreatitis: rationale, evidence, and recommendations.
Infectious complications are the most common cause of morbidity and mortality in patients suffering from severe acute pancreatitis. Approximately 25% of patients develop pancreatic necrosis. In these patients with severe disease complicated by necrosis, there is evidence that preventing infection of the pancreatic necrosis decreases morbidity and mortality. Whereas sterile necrosis is often treated conservatively, surgical debridement is required when the necrosis becomes infected. Although surgery is necessary in patients with infected necrosis, for a variety of reasons surgical intervention increases the morbidity and mortality of the disease. Preventing infectious complications, such as infected necrosis, through the use of prophylactic antibiotics is controversial. Despite reviewing the same evidence, different authors and organizations have formed different conclusions. In this review, we perform a critical analysis of the studies. Overall, the use of antibiotics in patients with necrotizing pancreatitis appears to decrease infectious complications and mortality.
Division of Gastroenterology, Department of Medicine, Maimonides Medical Center, Mount Sinai School of Medicine, Brooklyn, NY 11235, USA.
Issac
I
Moyshenyat
Ephraim
E
Mandell
Scott
S
Tenner
D019072:Antibiotic Prophylaxis / Q000592:standards* / Q000639:trends; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D018988:Bacterial Translocation; D003106:Colon / Q000382:microbiology; D018450:Disease Progression; D006801:Humans; D009336:Necrosis / Q000209:etiology / Q000382:microbiology; D010179:Pancreas / Q000473:pathology; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000401:mortality; D017410:Practice Guidelines as Topic; D011379:Prognosis