L. Gianotti et al., EFFECT OF DIFFERENT REGIMENS OF GUT DECONTAMINATION ON BACTERIAL TRANSLOCATION AND MORTALITY IN EXPERIMENTAL ACUTE-PANCREATITIS, The European journal of surgery, 161(2), 1995, pp. 85-92
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.