Pancreatic infection in severe pancreatitis - The role of fungus and multiresistance organisms

Hypothesis: Recent controlled clinical studies suggest a positive effect of early antibiotic treatment on late morbidity and mortality in severe acute pancreatitis. However, widespread use of antibiotics may lead to an increa sed number of fungal infections and multiresistant bacteria, thereby worsen ing the outcome of the disease. Design: Single-center prospective study. Setting: University hospital, gastrointestinal surgical service. Patients: One hundred three patients with necrotizing pancreatitis seen con secutively in our service. Interventions: In addition to standard treatment, patients with proven necr otizing pancreatitis received a prophy lactic intravenous antibiotic treatm ent. Pancreatic infection was regarded as an indication for surgery. Main Outcome Measures: Pancreatic infection, microbiological findings, drug resistance, fungal infections. Results: Thirty-three patients (32%) had in fected necrosis. Gram-negative organisms were isolated from 19 patients (58 %), Gram-positive organisms were isolated from 18 patients (55%), fungal or ganisms were isolated from 8 patients (24%), and multiresistant organisms w ere isolated from 3 patients (9%). In 7 patients (21%;), the organisms cult ured from the pancreatic tissue were resistant to the antibiotics given in for prophylaxis. Infection with multiresistant organisms or organisms resis tant to the antibiotic used for prophylaxis, but not with fungal infection or Gram-positive or Gram-negative infection, was correlated with a negative outcome. Conclusions: Fungal infection under adequate treatment is not associated wi th a negative outcome. The occurrence of multiresistant organisms seems to be a rare finding (3 of 103 patients), Antibiotic prophylaxis is effective in preventing infection in necrotizing pancreatitis, but optimal choice and duration of administration of the antibiotic agent(s) need to be carefully determined to avoid the sequelae of multiresistant organisms.