BACTEREMIA IN ACUTE-PANCREATITIS OF DIFFERENT ETIOLOGIES

To evaluate the rationale of using antibiotics in acute pancreatitis a nd to determine whether the indication for their use depends upon the etiology of the pancreatitis, the records of 202 patients with acute p ancreatitis were retrospectively reviewed. The incidence of abnormal b ody temperature, leukocytosis, bacteremia and the results of biochemis try tests in different etiologies of the disease were investigated. Pa ncreatitis was found to be alcohol-related (47 patients), gallstone-re lated (105 patients), idiopathic (26 patients) and miscellaneous (24 p atients). On admission, 83 patients had abnormal body temperature and 146 patients showed leukocytosis. Bacteremia occurred in 20 patients. Of these, 15 had gallstone-related pancreatitis, two had pancreatic ca ncers and one developed bacteremia after endoscopic retrograde cholang io-pancreatography (ERCP). These 18 patients had abnormal biochemistry results (including high serum levels of direct bilirubin, alkaline ph osphatase and gamma-glutamyltransferase) and dilated bile ducts on ima ging studies, indicating biliary infections. The remaining two patient s with bacteremia included one alcoholic patient and one patient with idiopathic pancreatitis. The most commonly involved pathogens were Esc herichia coli and Klebsiella pneumoniae. In addition, eight patients ( 4%) developed secondary pancreatic infections during hospitalization; the blood cultures of seven of these patients were negative on admissi on. Although fever and leukocytosis are not good predictors of infecti on in acute pancreatitis our results showed that bacteremia is common in patients whose pancreatitis is related to gallstones, ERCP or pancr eatic malignancy with obstructive jaundice. We recommend that antibiot ics be used only in this subset of acute pancreatitis patients.