title: Microbiologic analysis of peri-pancreatic fluid collected during EUS in patients with pancreatitis: impact on antibiotic therapy.
abstract: BACKGROUND
  Pancreatitis is a potentially life-threatening condition frequently accompanied by peri-pancreatic fluid collections (PPFC), such as pseudocysts or pancreatic necrosis. Aspiration of PPFCs during EUS interventions for microbiologic analysis is still rarely performed in clinical routine.
  
  
  OBJECTIVE
  To evaluate the role of routine microbiologic analysis of PPFCs and its impact on antibiotic therapy in patients with pancreatitis.
  
  
  METHODS
  Prospective, observational, multicenter study.
  
  
  METHODS
  Four treatment centers.
  
  
  METHODS
  A total of 44 consecutive patients who presented for endoscopic treatment of PPFCs were included.
  
  
  METHODS
  Concomitantly, PPFC during intervention and concomitant blood cultures were obtained.
  
  
  METHODS
  Microbiologic examination of PPFCs and blood samples.
  
  
  RESULTS
  Colonization of PPFCs was found in 59% of PPFC cultures, whereas all but 2 concomitant blood cultures showed no microbial growth. Risk factors for a colonization were the presence of necrosis (P = .006), acute pancreatitis (P = .033), leukocytosis (P = .001), elevated C-reactive protein levels (P = .003), fever (P = .02), turbid material (P = .031), and longer hospital stay (P = .003). In 23 patients with fluid colonization despite empiric antibiotic therapy, the treatment had to be adjusted in 18 patients (78%) according to the observed antibiotic susceptibility profile.
  
  
  CONCLUSIONS
  Contamination cannot be totally excluded.
  
  
  CONCLUSIONS
  The microbiologic colonization of PPFCs in patients with pancreatitis is common. Only the direct microbiologic analysis of PPFCs, but not of blood cultures, is useful to optimize an effective antibiotic therapy in patients with pancreatitis.
authors: Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.
authors: Ahmed A
authors: AA
authors: Negm
authors: Hendrik
authors: H
authors: Poos
authors: Elmar
authors: E
authors: Kruck
authors: Ralf-Peter
authors: RP
authors: Vonberg
authors: Dirk
authors: D
authors: Domagk
authors: Ahmed
authors: A
authors: Madisch
authors: Torsten
authors: T
authors: Voigtländer
authors: Michael P
authors: MP
authors: Manns
authors: Jochen
authors: J
authors: Wedemeyer
authors: Tim O
authors: TO
authors: Lankisch
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D015169:Colony Count, Microbial; D020420:Cyst Fluid / Q000382:microbiology*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging*; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000382:microbiology*; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D019512:Pancreatitis, Alcoholic / Q000000981:diagnostic imaging / Q000382:microbiology; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging / Q000382:microbiology; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: EUS-FNA; EUS-guided FNA; PPFC; peri-pancreatic fluid collection