Pancreatitis and Associated Infections

Abstract

Pancreatitis.associatedinfections (PAI) are among of the most serious complications of acute pancreatitis. Only about 5–7% of all patients with diagnosis of acute pancreatitis develop infection, but in patients with severe necrotizing pancreatitis and extended pancreatic necrosis their rates may be as high as 40–70%. Infectious complications of the pancreatitis are responsible for 70–80% of deaths in patients with acute pancreatitis. The main types of PAI are infected pancreatic necrosis, pancreatic and peripancreatic abscesses and infected pseudocysts. Etiology of PAI is often polymicrobial and involves both aerobic and anaerobic bacteria. Clinical trials show benefits from the early prophylactic administration of antibiotic to patients with severe pancreatitis. Choice of antimicrobial agents should be based primarily on susceptibility patterns of the organisms most commonly recovered from patients with PAI. Penetration of antibiotics into pancreatic and peripancreatic tissue should be another determinant factor. In most cases antibacterial therapy combines with surgical treatment. Antimicrobial choices are carbapenems, a third generation cephalosporin or ciprofloxacin combined with metronidazole or clindamycin, and inhibitor-protected β-lactams.