Preventing pancreatic infection in acute pancreatitis

In acute pancreatitis, pancreatic inflammation may be complicated by the de velopment of pancreatic infection with a high associated mortality Pancreat ic infection is related to the extent of pancreatic inflammation and necros is and typically occurs in the second or third week of severe disease. It m ay be associated with a wide range of Gram-positive and Gram-negative bacte ria, notably enterobacteria and also with Candida spp. Current surgical pra ctice in the UK is to use prophylactic antimicrobial therapy in patients wi th severe disease, with the aim of preventing secondary pancreatic infectio n. Experimental evidence demonstrates that prophylactic antibacterial thera py prevents pancreatic infection and reduces mortality. Furthermore, studie s of antibacterial prophylaxis in patients with acute pancreatitis suggest that prophylactic antibacterial therapy is associated with a reduction in m ortality, particularly in those with severe disease. In general, broad-spec trum antibiotics have been used in animal and human studies. However, curre nt evidence does not allow comparisons to be made between different antimic robial agents. Nutritional strategies may also be important in the preventi on of pancreatic infection. Enteral, rather than parenteral, nutrition has been associated with an improved clinical outcome in severe pancreatitis. ( C) 2000 The Hospital Infection Society.