Effect of Early Antibiotic Treatment Strategy on Prognosis of Acute Pancreatitis

Overview

Journal BMC Gastroenterol

Publisher Biomed Central

Specialty Gastroenterology

Date 2023 Dec 8

PMID 38066411

Authors

Yi Wen

Lili Xu

Dayi Zhang

Wenwu Sun

Zaiqian Che

Bing Zhao

Ying Chen

Zhitao Yang

Erzhen Chen

Tongtian Ni

Enqiang Mao

Affiliations

Soon will be listed here.

Abstract

Background: Antibiotic use in the early stages of acute pancreatitis is controversial. The purpose of this study was to investigate the effect of early antibiotic application on the prognosis of acute pancreatitis (AP).

Materials And Methods: Clinical data of patients with primary AP admitted to our emergency ward within 72 hours of onset were retrospectively collected from January 2016 to December 2020. We classified patients with acute pancreatitis according to etiology and disease severity, and compared the differences in hospital stay, laparotomy rate, and in-hospital mortality among AP patients who received different antibiotic treatment strategies within 72 hours of onset.

Results: A total of 1134 cases were included, with 681 (60.1%) receiving early antibiotic treatment and 453 (39.9%) not receiving it. There were no significant differences in baseline values and outcomes between the two groups. In subgroup analysis, patients with biliary severe acute pancreatitis (SAP) who received early antibiotics had lower rates of laparotomy and invasive mechanical ventilation, as well as shorter hospital stays compared to those who did not receive antibiotics. In logistic regression analysis, the early administration of carbapenem antibiotics in biliary SAP patients was associated with a lower in-hospital mortality rate. Early antibiotic use in biliary moderate-severe acute pancreatitis (MSAP) reduced hospital stays and in-hospital mortality. Quinolone combined with metronidazole treatment in biliary mild acute pancreatitis (MAP) shortened hospital stays. Early antibiotic use does not benefit patients with non-biliary AP.

Conclusion: Strategies for antibiotic use in the early stages of AP need to be stratified according to cause and disease severity.

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References

Werge M, Novovic S, Schmidt P, Gluud L . Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis. Pancreatology. 2016; 16(5):698-707. DOI: 10.1016/j.pan.2016.07.004. View

Jiang K, Huang W, Yang X, Xia Q . Present and future of prophylactic antibiotics for severe acute pancreatitis. World J Gastroenterol. 2012; 18(3):279-84. PMC: 3261546. DOI: 10.3748/wjg.v18.i3.279. View

Poropat G, Radovan A, Peric M, Mikolasevic I, Giljaca V, Hauser G . Prevention of Infectious Complications in Acute Pancreatitis: Results of a Single-Center, Randomized, Controlled Trial. Pancreas. 2019; 48(8):1056-1060. DOI: 10.1097/MPA.0000000000001368. View

Ukai T, Shikata S, Inoue M, Noguchi Y, Igarashi H, Isaji S . Early prophylactic antibiotics administration for acute necrotizing pancreatitis: a meta-analysis of randomized controlled trials. J Hepatobiliary Pancreat Sci. 2015; 22(4):316-21. DOI: 10.1002/jhbp.221. View

Guo D, Dai W, Shen J, Zhang M, Shi Y, Jiang K . Assessment of Prophylactic Carbapenem Antibiotics Administration for Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis. Digestion. 2022; 103(3):183-191. DOI: 10.1159/000520892. View

Garret C, Canet E, Corvec S, Boutoille D, Peron M, Archambeaud I . Impact of prior antibiotics on infected pancreatic necrosis microbiology in ICU patients: a retrospective cohort study. Ann Intensive Care. 2020; 10(1):82. PMC: 7295875. DOI: 10.1186/s13613-020-00698-0. View

Isenmann R, Runzi M, Kron M, Kahl S, Kraus D, Jung N . Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial. Gastroenterology. 2004; 126(4):997-1004. DOI: 10.1053/j.gastro.2003.12.050. View

Di Vincenzo F, Nicoletti A, Negri M, Vitale F, Zileri Dal Verme L, Gasbarrini A . Gut Microbiota and Antibiotic Treatments for the Main Non-Oncologic Hepato-Biliary-Pancreatic Disorders. Antibiotics (Basel). 2023; 12(6). PMC: 10295019. DOI: 10.3390/antibiotics12061068. View

Nordback I, Sand J, Saaristo R, Paajanen H . Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis--a single-center randomized study. J Gastrointest Surg. 2001; 5(2):113-8; discussion 118-20. DOI: 10.1016/s1091-255x(01)80021-4. View

10.

Petrov M, Yadav D . Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol. 2018; 16(3):175-184. PMC: 6597260. DOI: 10.1038/s41575-018-0087-5. View

11.

Moggia E, Koti R, Belgaumkar A, Fazio F, Pereira S, Davidson B . Pharmacological interventions for acute pancreatitis. Cochrane Database Syst Rev. 2017; 4:CD011384. PMC: 6478067. DOI: 10.1002/14651858.CD011384.pub2. View

12.

Howard T . The role of antimicrobial therapy in severe acute pancreatitis. Surg Clin North Am. 2013; 93(3):585-93. DOI: 10.1016/j.suc.2013.02.006. View

13.

de Vries A, Besselink M, Buskens E, Ridwan B, Schipper M, van Erpecum K . Randomized controlled trials of antibiotic prophylaxis in severe acute pancreatitis: relationship between methodological quality and outcome. Pancreatology. 2007; 7(5-6):531-8. DOI: 10.1159/000108971. View

14.

Guo X, Li Y, Lin H, Cheng L, Huang Z, Lin Z . A nomogram for clinical estimation of acute biliary pancreatitis risk among patients with symptomatic gallstones: A retrospective case-control study. Front Cell Infect Microbiol. 2022; 12:935927. PMC: 9380850. DOI: 10.3389/fcimb.2022.935927. View

15.

Barrie J, Jamdar S, Smith N, McPherson S, Siriwardena A, OReilly D . Mis-use of antibiotics in acute pancreatitis: Insights from the United Kingdom's National Confidential Enquiry into patient outcome and death (NCEPOD) survey of acute pancreatitis. Pancreatology. 2018; 18(7):721-726. DOI: 10.1016/j.pan.2018.05.485. View

16.

Ni T, Wen Y, Zhao B, Ning N, Chen E, Mao E . Characteristics and risk factors for extrapancreatic infection in patients with moderate or severe acute pancreatitis. Heliyon. 2023; 9(2):e13131. PMC: 9900262. DOI: 10.1016/j.heliyon.2023.e13131. View

17.

Banks P, Bollen T, Dervenis C, Gooszen H, Johnson C, Sarr M . Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2012; 62(1):102-11. DOI: 10.1136/gutjnl-2012-302779. View

18.

Pezzilli R, Morselli-Labate A . Alcoholic pancreatitis: pathogenesis, incidence and treatment with special reference to the associated pain. Int J Environ Res Public Health. 2010; 6(11):2763-82. PMC: 2800061. DOI: 10.3390/ijerph6112763. View

19.

Montravers P, Kantor E, Constantin J, Lefrant J, Lescot T, Nesseler N . Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study. Crit Care. 2019; 23(1):393. PMC: 6896276. DOI: 10.1186/s13054-019-2681-5. View

20.

Mederos M, Reber H, Girgis M . Acute Pancreatitis: A Review. JAMA. 2021; 325(4):382-390. DOI: 10.1001/jama.2020.20317. View