Early prophylactic antibiotics for severe acute pancreatitis: A population-based cohort study using a nationwide database in Japan

Nakaharai, Kazuhiko; Morita, Kojiro; Jo, Taisuke; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

doi:10.1016/j.jiac.2018.05.009

Cited by 25 publications

(18 citation statements)

References 39 publications

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“…15 Other studies have reported not only that the use of antibiotic prophylaxis has no significant clinical benefit, but also that it is associated with an increased intrahospital infection risk; therefore, the use of antibiotic treatment must be reserved only for patients with local infection or sepsis. 16,17 These numbers are consistent with our study, where we reported that the group that received antibiotic prophylaxis had more local complications than the group that did not use prophylaxis (p=0.01) (Table 3).…”

Section: Discussionsupporting

confidence: 90%

Comparison of use and non-use of prophylactic antibiotics for severe acute pancreatitis

et al. 2021

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Background: Acute pancreatitis is a frequent disease in Chile, with mortality rate of 10-30%. Prophylactic antibiotics administration has been part of severe acute pancreatitis treatment for theoretical prevention of infectious complications and mortality reduction. Yet the available evidence is controversial. The aim of the study was to demonstrate that prophylactic antibiotics do not reduce complications, need for intensive care unit bed or mortality in severe acute pancreatitis.Methods: Randomized clinical trial with simple randomization using a computational table (use or non-use of prophylactic antibiotics) of patients with severe acute pancreatitis. We define severe acute pancreatitis as APACHE II ≥8, C-reactive protein ≥150. In prophylactic antibiotics use group, ciprofloxacin and metronidazole were administered for 7 days. This preliminary report is presented with 50% of the calculated sample.Results: N=150, two randomized groups; group 1 (n=73), without prophylactic antibiotics use, and group 2 (n=77) with antibiotic prophylaxis use. Twenty-four patients (16%) required intensive care unit bed; twelve in group 1, and twelve in group 2 (p=0.53). Ten patients (6.66%) had some type of complication, one in group 1 and nine in group 2 (p=0.01). The average hospital stay was 15.7±9.0 days in group 1, and 16.8±17.9 days in group 2 (p=0.57). Mortality was four patients (2.66%), one in group 1 and three in group 2 (p=0.33).Conclusions: In this preliminary report, the prophylactic antibiotics use for severe acute pancreatitis was not shown to reduce complications, need for an intensive care unit bed or mortality.

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Section: Discussionsupporting

confidence: 90%

Comparison of use and non-use of prophylactic antibiotics for severe acute pancreatitis

et al. 2021

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“…As reported, using antibacterial agents in patients with AP is a common clinical practice all over the world. There is no doubt though that the early and long-term use of antibiotics can provoke intestinal dysbiosis with subsequent dissemination of multiresistant strains of bacteria and fungi, including those that make up normal human microbiota [ 11 , 12 ]. The current concepts and evidence concerning this problem have earned special attention in the literature [ 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

Аntibacterial and Antifungal Therapy for Patients with Acute Pancreatitis at High Risk of Pancreatogenic Sepsis (Review)

Firsova¹,

Паршиков

Кукош

et al. 2020

Sovrem Tehnol Med

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Controlling infection is crucial in treating patients with acute pancreatitis (AP). The infectious process in AP often predisposes to subsequent sepsis by damaging not only the pancreas, but retroperitoneal tissues as well. Among other AP-associated factors, are the rapidly developing immune imbalance, the poor penetration of antimicrobial agents into necrotic tissue, and the impossibility of a single surgical debridement. Antibacterial and antifungal therapy for patients with infected necrosis and AP-associated extra-pancreatic infections remains a complex and largely unresolved problem, partially due to the high occurrence of multiresistant pathogens. The preventive use of antimicrobial agents has been discussed in the literature; however, the lack of consistent results makes it difficult to develop a unified strategy and clinical guidelines on this specific issue. Recent meta-analyses provide no conclusive evidence that antibacterial prophylaxis reduces the infection rate, mortality, or the need for surgical treatment in patients with necrotizing pancreatitis. We found only two studies indicating the benefits of using carbapenems for prophylactic purposes and one meta-analysis indicating a reduction in mortality under antibiotic treatment started no later than 72 h after the onset of the attack. Selective bowel decontamination is considered as one of the preventive anti-infection measures, although the available data may not be fully reliable. The main indications for antibacterial therapy in patients with AP are confirmed infected necrosis or extra-pancreatic infection, as well as clinical symptoms of suspected infection. Intra-arterial administration or local treatment with antibiotics can increase the efficacy of antibacterial therapy. No randomized studies on antifungal prophylaxis in AP are available; some reports though recommend using such therapy among patients at high risk of invasive candidiasis.

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“…As the intestinal microecosystem is the largest micro-ecosystem in the human body, when it is out of balance, the host's metabolism and the metabolism of its toxic products are affected. A SIRS (including acute pancreatitis) can be easily induced at this time (40). Based on the results of existing animal studies and clinical application trials of probiotic therapies, it appears that probiotics therapy may be a double-edged sword.…”

Section: Discussionmentioning

confidence: 99%

The role of gut microbiota in the pathogenesis and treatment of acute pancreatitis: a narrative review

Lu¹,

Chen²,

Ni³

et al. 2021

Ann Palliat Med

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Early prophylactic antibiotics for severe acute pancreatitis: A population-based cohort study using a nationwide database in Japan

Cited by 25 publications

References 39 publications

Comparison of use and non-use of prophylactic antibiotics for severe acute pancreatitis

Comparison of use and non-use of prophylactic antibiotics for severe acute pancreatitis

Аntibacterial and Antifungal Therapy for Patients with Acute Pancreatitis at High Risk of Pancreatogenic Sepsis (Review)

The role of gut microbiota in the pathogenesis and treatment of acute pancreatitis: a narrative review

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