EFFECT OF DIFFERENT REGIMENS OF GUT DECONTAMINATION ON BACTERIAL TRANSLOCATION AND MORTALITY IN EXPERIMENTAL ACUTE-PANCREATITIS

Objective: To assess the effect of four regimens of antibiotics (compa red with a control regimen of distilled water) given orally on gut dec ontamination, bacterial translocation, and mortality in acute necrotis ing pancreatitis in mice. Design: Randomised experimental study. Setti ng: University hospitals, USA and Italy. Materials: 150 young Swiss We bster mice. Intervention: All mice were fed a diet deficient in cholin e and supplemented with ethionine. They were then randomised to be giv en by gavage (36 hours after starting the diet): distilled water (cont rols, group 1); aztreonam alone (group 2); neomycin, erythromycin, met ronidazole (group 3); polymyxin B and amikacin (group 4); polymyxin B, amikacin, amphotericin B (group 5). 20 Mice in each group were treate d for 10 days, and the remaining 10 in each group were killed after 3 days. Main outcome measures: Survival, and qualitative and quantitativ e cultures of the liver, lungs, pancreas and caecum. Results: The best survival rate during the first 7 days was in group 5, but by day 10 t here was no difference among the groups. All the antibiotic regimens r educed the number of bacteria in the caecum and all but aztreonam alon e (group 2) reduced the rate of translocation of both Gram negative an d Gram positive bacteria to all organs studied. Translocation of yeast occurred in those animals in groups 2, 3, and 4 in which there was ov ergrowth of fungi in the caecum. Conclusion: Gram negative and Gram po sitive organisms and fungi may have an important role in infective mor bidity and mortality in acute pancreatitis, and selective decontaminat ion with polymyxin B, amikacin, amphotericin B reduced the incidence o f translocation related infections and early mortality in mice with ac ute necrotising pancreatitis.