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

Abstract

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.

Impact of multiple drug-resistant Gram-negative bacterial bacteraemia on infected pancreatic necrosis patients

“…Uncontrollable bacteraemia, secondary to AP, may play a key role in this prognosis. This is the first case–control study that has focused on the impact of MDR-GNB bacteraemia on IPN patients, and the mortality of IPN in this study was up to 26.4% in accordance with previous studies, which highlighted that MDR-GNB has become a serious pathogen of infections among AP patients ( Jain et al., 2018 ; Firsova et al., 2020 ).…”

Selective and Concentrative Enteropancreatic Recirculation of Antibiotics by Pigs

“…Antibiotics are an important component of therapy for treatment of pancreatitis associated with bacterial infection [1][2][3], though with some risk [4]. The selection of specific antibiotics for the treatment of infectious pancreatitis is largely based on a combination of bacterial sensitivity, penetration into pancreatic tissue after intravenous administration, and the presence in PES above minimal inhibitory concentrations [5].…”