Management of infected pancreatic necrosis in the intensive care unit: a narrative review

Wolbrink, Daan; Kolwijck, Eva; Oever, Jaap ten; Horvath, Karen D.; Bouwense, Stefan; Schouten, Jeroen

doi:10.1016/j.cmi.2019.06.017

Cited by 38 publications

(34 citation statements)

References 74 publications

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“…SAP is a critical condition with poor prognosis in the clinic. The mortality rate may be up to 30% 1 due to local and systemic complications, including systemic in ammatory response syndrome (SIRS), acute respiratory distress syndrome (ARDS) or multiple organ dysfunction syndrome (MODS) in the early stage [2][3][4] . Subsequently, infectious pancreatic necrosis (IPN) will appear in approximately 40% to 70% of patients in the second stage [5][6] , and the mortality rate can be as high as 32% to 50% [7][8] Currently, the treatment of IPN has evolved from open surgery to comprehensive treatment based on minimally invasive techniques, such as endoscopic treatments, percutaneous drainage and minimally invasive necrotic tissue removal 9-11 . Antibiotics are used for almost the entire treatment process 12 .…”

Section: Introductionmentioning

confidence: 99%

Compositional and drug-resistance profiling of pathogens in patients with severe acute pancreatitis: a retrospective study

Fan

Hong

et al. 2020

Preprint

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Background: Infection is one of the important causes of death in patients with severe acute pancreatitis (SAP) , but the bacterial spectrum and antibiotic resistance are constantly changing. Making good use of antibiotics and controlling multi-drug-resistant (MDR) bacterial infections are of vital importance in improving the cure rate of SAP. We conducted a retrospective study in the hope of providing references for antibiotic selection and control of drug-resistant bacteria. Methods: Retrospective analysis was performed on the data of patients hospitalized in our hospital due to acute pancreatitis (AP) in the past 5 years. General data were classified and statistically analyzed. Subsequently, the bacterial spectrum characteristics and the data related to drug-resistant bacterial infection of 569 AP patients were analyzed. Finally, unconditional logistic regression analysis was conducted to analyze the risk factors of MDR infection. Results: A total of 398 patients were enrolled in this study and the hospitalization data and associated results were analyzed. A total of 461 strains of pathogenic bacteria were detected, including 223 (48.4%) gram-negative bacterial strains, 190 (41.2%) gram-positive bacterial strains and 48 (10.4%) fungal strains. The detection rates of resistance in gram-negative and gram-positive bacterial strains were 48.0% (107/223) and 25.3% (48/190), respectively. There were significant differences between the MDR group and the non-MDR group for the factors of precautionary antibiotic use, kinds of antibiotics used, receipt of carbapenem, tracheal intubation, hemofiltration and number of hospitalization days in the intensive care unit. Unconditional logistic regression revealed 2 risk factors for MDR bacterial infection. Conclusions: Our results illustrate that gram-negative bacteria were the most common pathogens in SAP infection, and the proportion of gram-positive bacteria increased notably. The rate of antibiotic resistance was higher than previously reported. Unconditional logistic regression analysis showed that using more types of antibiotics and the number of hospitalization days in the ICU were the risk factors associated with MDR bacterial infection.

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Section: Introductionmentioning

confidence: 99%

Compositional and drug-resistance profiling of pathogens in patients with severe acute pancreatitis: a retrospective study

Fan

Hong

et al. 2020

Preprint

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“…However, more uncommon infections may also be encountered in ICU patients, either as a reason for admission or as a complication during the ICU stay. In this issue of Clinical Microbiology and Infection, we focus on three uncommon yet severe infections: necrotizing skin and tissue infection [8], pancreatic infection [9] and mediastinitis [10]. By definition uncommon infections have a low prevalence, which often means that experience in treating these infections is diluted.…”

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confidence: 99%

“…Pancreatitis and mediastinitis share a number of features [9,10]. First, they are often difficult to diagnose.…”

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confidence: 99%

“…Another feature shared by the patients with such infections is the lack of consensus about the best duration of antimicrobial treatment. Five to 7 days, 7e14 days and 14e21 days are suggested for pancreatic infections [9], necrotizing skin and tissue infections [8], and mediastinitis [10], respectively. However, these durations are only based on expert opinion e no adequate randomized clinical trials were conducted to test different durations in the ICU patients.…”

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confidence: 99%

“…In addition, the duration of antibiotic treatment is conditioned by the quality of source control, which remains often uncertain in these patients. Hence, experts advocate a duration adapted for each patient based on clinical response and repeated CT scans [9,10], but this again needs to be demonstrated in highquality studies.…”

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confidence: 99%

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Improving care for the ICU patient with suspected infection: a multidisciplinary perspective

Léone

Pulcini

Waele

2020

Clinical Microbiology and Infection

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Improving care for the ICU patient with suspected infection: a multidisciplinary perspective Infection is a major cause of morbidity and mortality in intensive care unit (ICU) patients, and multidrug-resistant infections are encountered on a daily basis in most ICUs globally. An international prevalence survey providing a 1-day picture showed that an infection was suspected or proven in 51% of ICU patients, with 71% of ICU patients receiving antibiotics on this specific day. In this international survey, methicillin-resistant Staphylococcus aureus, Pseudomonas species, Acinetobacter species and Gram-negative bacteria producing extended spectrum b-lactamases accounted for 10.2%,

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Indications for Interventional and Surgical Treatment of Necrotizing Pancreatitis

Saadat

Clancy

2023

The Pancreas

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Management of infected pancreatic necrosis in the intensive care unit: a narrative review

Cited by 38 publications

References 74 publications

Compositional and drug-resistance profiling of pathogens in patients with severe acute pancreatitis: a retrospective study

Compositional and drug-resistance profiling of pathogens in patients with severe acute pancreatitis: a retrospective study

Improving care for the ICU patient with suspected infection: a multidisciplinary perspective

Indications for Interventional and Surgical Treatment of Necrotizing Pancreatitis

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