title: Treatment strategy against infection: clinical outcome of continuous regional arterial infusion, enteral nutrition, and surgery in severe acute pancreatitis.
abstract: BACKGROUND
  In severe acute pancreatitis (SAP), infectious complications are the main contributors to high mortality. Since 1995, we have performed continuous regional arterial infusion of protease inhibitor and antibiotics (CRAI) and enteral nutrition (EN) as prevention therapies against infection. When infected pancreatic necrosis was proven, surgical intervention was adapted. The aim of this study was to investigate the clinical outcome of these treatments.
  
  
  METHODS
  We examined the relationship between the historical change of treatment strategy and clinical outcome. We divided 84 patients with acute necrotizing pancreatitis into two groups, CRAI (-) and CRAI (+), and compared the outcome. We divided 145 patients with SAP into two groups, EN (-) and EN (+), and compared the outcome. We also analyzed the outcome of surgical treatment.
  
  
  RESULTS
  In the CRAI (+) group, the incidence of infection, the frequency of surgery, and the mortality rate were lower than those in CRAI (-) group: 34% versus 51%, 27% versus 63% (P < 0.05), and 37% versus 54%, respectively. In the EN (+) group, the frequency of surgery and the mortality rate were lower than those in the EN (-) group: 23% versus 32% and 19% versus 35% (P < 0.05), respectively. These improvement effects were manifest in stage 3 (9 < or = Japanese Severity Score < or = 14). Treatment outcome of necrosectomy for infected pancreatic necrosis was still poor. Bleeding and abscess-gut fistula were postoperative life-threatening complications.
  
  
  CONCLUSIONS
  CRAI and EN may improve the clinical outcome of SAP, reducing infection and averting pancreatic surgery.
authors: Department of Gastroenterological Surgery, Kobe University Graduate School of Medical Sciences, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
authors: Takeo
authors: T
authors: Yasuda
authors: Takashi
authors: T
authors: Ueda
authors: Yoshifumi
authors: Y
authors: Takeyama
authors: Makoto
authors: M
authors: Shinzeki
authors: Hidehiro
authors: H
authors: Sawa
authors: Takahiro
authors: T
authors: Nakajima
authors: Ippei
authors: I
authors: Matsumoto
authors: Tsunenori
authors: T
authors: Fujita
authors: Tetsuya
authors: T
authors: Sakai
authors: Tetsuo
authors: T
authors: Ajiki
authors: Yasuhiro
authors: Y
authors: Fujino
authors: Yoshikazu
authors: Y
authors: Kuroda
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D001550:Benzamidines; D044963:Biopsy, Fine-Needle; D004359:Drug Therapy, Combination; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005341:Fibrinolysin / Q000037:antagonists & inhibitors; D005500:Follow-Up Studies; D006146:Guanidines / Q000008:administration & dosage; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage; D015994:Incidence; D007261:Infusions, Intra-Arterial; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011480:Protease Inhibitors / Q000008:administration & dosage*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001550:Benzamidines; D006146:Guanidines; D011480:Protease Inhibitors; D015378:Imipenem; D005341:Fibrinolysin; C032855:nafamostat
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