Antibiotic Prophylaxis of Infectious Complications of Acute Pancreatitis - the Results of Randomised Study by meropenem
Spicak J., Hejtmankova S., Hubaczova M., Antos F., Bartova J., Cech P., Kasalicky M., Kostka R., Lata J., Leffler J., Solar S., Svoboda P., Zavoral M.
Klinika hepatogastroenterologie Trans plantacni centrum IKEM, Praha Chirurgicka klinika Fakultni nemocnice Na Bulovce, Praha Komplementarni centrum vnitfniho lekafstvi, II. intern! klinika Fakultni nemocnice v Hradci Kralove Chirurgicka klinika Fakultni Thomayerovy nemocnice, Praha I. chirurgicka klinika Vseobecne fakultni nemocnice v Praze Chirurgicka klinika Fakultni nemocnice Kralovske Vinohrady, Praha III. interni klinika Fakultni nemocnice Brno-Bohunice I. chirurgicka klinika Fakultni nemocnice v Motole, Praha Traumatologicky ustav, Brno II. interni oddeleni Ustfedni vojenske nemocnice v Praze |
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Summary:
The aim: Infectious complications are the most common cause of death from acute pancreatitis. The aim of our study was an evaluation of antibiotics prophylaxis on the course of serious acute pancreatitis.
Methods: Patients into randomised multicentric study was included according to Atlanta's consensus or if the value of C-reactive protein was more than 190 ml/1. In the treated group meropenem was given in a dose 0.5 g three times a day at least for 10 days. In a control group the same antibiotics was given only by proving of infectious complications or at least serious suspicition to it.
Results: Total number of 41 patients was included in this study, 20 in the prophylactis group (7 women, 13 men) and the control group was 21 patients (3 women, 18 men). The most common cause of pancreatitis was biliary and alcoholic (14 patients each). In the prophylactic treated group the average hospitalisation time was 18 ± 7.2 days, in the control group 25 ± 14.8 days. In a prophylactic resp. control group 7 resp. 4 patients underwent ERCP with papilosfincterotomy in 4 resp. 2 patients. Surgery was done in treated group 4 patients, in a prophylactic group 5 patients. In the prophylactic group 4 patients (20%) had died and in control group 5 patients (23.8%). The cause of death was a sepsis in all 4 patients prophylactic group, in the treated group pulmonary embolism (1) and sepsis (4). Local complications were mentioned in 13 patients in the
treated group and 12 patients in a control group (pancreatic necrosis 9 resp. 7 patients). Infectious complications in 5 resp. 7 in both groups. The difference in followed parameters were not statistically significant. The change of antibiotic prophylaxis was necessary in treated group in 4 patients (20%) average 11.25 days after admission but in a control group in 13 patients (62%) average 7.25 days after beginning from disease. Stapfylococcus aureus and Pseudomonas aeruginosa were the most common pathogen cultivated in infectious complications.
Conclusions: Our study did not prove any advantage of antibiotic prophylaxis in acute pancreatitis management. The cause can be seen in methodological problems which are very difficult to miss or inefectiveness of prophylaxis. Key words: acute pancreatitis — antibiotic prophylaxis — meropenem
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