Bacterial Infection of Pancreatic Necrosis: Role of Bacterial Translocation, Impact of Antibiotic Treatment

Isenmann, Rainer; Beger, H. G.

doi:10.1159/000055798

Cited by 25 publications

(19 citation statements)

References 64 publications

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“…However, the extent of necrosis may not be as important in the morbidity and mortality of necrotizing pancreatitis as was once thought. While some series have shown a correlation between extent of necrosis and prevalence of organ failure (66,69,148,161), others have not (50,83,111); similarly, while some series have shown a correlation between the extent of necrosis and the prevalence of infected necrosis (117,161,175), others have not (83,91,111); while one recent study has shown a correlation of extent of necrosis with mortality (161), others have not (83,128,138).…”

Section: Level Of Evidence: IIImentioning

confidence: 99%

Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,677

980

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Section: Level Of Evidence: IIImentioning

confidence: 99%

Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,677

980

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“…The role of antibiotics in reducing infectious morbidity and mortality has been debated for decades because of a lack of supportive clinical data. Research completed over the past decade has helped to define the microbiology, establish the risk factors, and improve the understanding of the pathogenesis of infectious complications in patients with ANP [181]. These patients are at the greatest risk of developing an infection with enteric Gram-negative or Gram-positive bacteria 'translocated' from the bowel lumen into the necrotic pancreatic tissue [181,182].…”

Section: Selective Bowel Decontamination In Acute Pancreatitismentioning

confidence: 99%

Rifaximin, a Poorly Absorbed Antibiotic: Pharmacology and Clinical Potential

2005

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Rifaximin (4-deoxy-4′-methylpyrido[1′,2′-1,2]imidazo- [5,4-c]-rifamycin SV) is a synthetic antibiotic designed to modify the parent compound, rifamycin, in order to achieve low gastrointestinal (GI) absorption while retaining good antibacterial activity. Both experimental and clinical pharmacology clearly show that this compound is a nonsystemic antibiotic with a broad spectrum of antibacterial action covering Gram-positive and Gram-negative organisms, both aerobes and anaerobes. Being virtually nonabsorbed, its bioavailability within the GI tract is rather high with intraluminal and fecal drug concentrations that largely exceed the minimal inhibitory concentration values observed in vitro against a wide range of pathogenic organisms. The GI tract represents, therefore, the primary therapeutic target and GI infections the main indication. The appreciation of the pathogenic role of gut bacteria in several organic and functional GI diseases has increasingly broadened its clinical use, which is now extended to hepatic encephalopathy, small intestine bacterial overgrowth, inflammatory bowel disease and colonic diverticular disease. Potential indications include the irritable bowel syndrome and chronic constipation, Clostridium difficile infection and bowel preparation before colorectal surgery. Because of its antibacterial activity against the microorganism and the lack of strains with primary resistance, some preliminary studies have explored the rifaximin potential for Helicobacter pylori eradication. Oral administration of this drug, by getting rid of enteric bacteria, could also be employed to achieve selective bowel decontamination in acute pancreatitis, liver cirrhosis (thus preventing spontaneous bacterial peritonitis) and nonsteroidal anti-inflammatory drug (NSAID) use (lessening in that way NSAID enteropathy). This antibiotic has, therefore, little value outside the enteric area and this will minimize both antimicrobial resistance and systemic adverse events. Indeed, the drug proved to be safe in all patient populations, including young children. Although rifaximin has stood the test of time, it still attracts the attention of both basic scientists and clinicians. As a matter of fact, with the advancement of the knowledge on microbial-gut interactions in health and disease novel indications and new drug regimens are being explored. Besides widening the clinical use, the research on rifaximin is also focused on the synthesis of new derivatives and on the development of original formulations designed to expand the spectrum of its clinical use.

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“…As has been previously described, gut barrier dysfunction and bacterial translocation with secondary infection can be indirect indications of the inflammatory process severity [8,9,30] . Pancreatic infection has been identified as the main determinant of morbidity and mortality in SAP [31] .…”

Section: Discussionmentioning

confidence: 81%

“…TNF-␣ seems to play a key role as a mediator of inflammation and cellular immune responses in AP, and antibody against TNF-␣ or blockade of TNF-␣ production can be an alternative to attenuate SAP [5][6][7] . Systemic inflammatory response can damage the intestinal barrier leading to bacterial translocation and pancreatic infection, which is an important factor for complications and mortality in AP [8,9] .…”

Section: Introductionmentioning

confidence: 99%