INFECTIONS COMPLICATING PANCREATITIS - DIAGNOSING, TREATING, PREVENTING

The most important risk factor in patients suffering from acute necrot izing pancreatitis is pancreatic infection, a factor that determines t he course of the disease, its therapeutic management, and its outcome. The bacterial infection route is very likely via the colon, in patien ts with acute pancreatitis, the infection rate is about 40 to 70% with in the first 3 wks, Bacteria most frequently found are those from the gastrointestinal tract: Escherichia coli, Pseudomonas species, Strepto coccus fecalis, Enterococcus, and Staphylococcus aureus. Screening met hods for infected necrotizing pancreatitis include hue needle puncture by ultrasonography or computed tomographic guidance with Gram stainin g and culture of the aspirate. me previously investigated different br oad-spectrum antibiotics with regard to their efficacy at preventing i nfection. This analysis indicated that antibiotics have different effi cacy factors based on pharmacodynamic properties. Imipenem and quinolo nes, in combination with metronidazole, are the drugs of choice for tr eating or preventing pancreatic infection, whereas aminoglycosides do not enter the pancreas and therefore are not indicated. Based on incre asing evidence that patients with acute necrotizing pancreatitis will benefit by early and appropriate antibiotic therapy, we altered the ap proach in such patients with an immediate start of antibiotic therapy continued for at least 14 days. We have found a reduction of the infec tion rate to 33% (11/32) in the third week after the onset of the dise ase. This treatment of the infection and the possibility of delaying o perative intervention resulted in optimal surgical conditions. However , further prospective, controlled, and randomized studies are necessar y to determine which antibiotics and antimycotic therapeutic regimens should be chosen.