急性重症胰腺炎的抗生素预防用药（英文PPT）Prophylactic Antibiotics in Severe Acute Pancreatitis - Crit-IQ.ppt

Prophylactic Antibiotics in Severe Acute Pancreatitis Introduction Acute pancreatitis spectrum of disease; mild, self-limiting disease requiring brief hospitalisation Rapidly progressive, fulminant illness resulting in multi-organ failure, with mortality of 30-50%, months in hospital Management Resuscitation Analgesia Investigation Enteral nutrition ERCP Surgery Pharmacological agents Supportive Prophylactic antibiotics Prophylactic Antibiotics Prophylactic Antibiotics Experimental theory bacterial translocation from colon Polymicrobial – enterobacter, staph, enterococci, streptococci, anaerobes, pseudomonas, acinetobacter, candida. Candida spp. More common SAP, use of broad spectrum antibiotics. Incidence up to 30% of necrotising pancreatitis, associated higher mortality. Intravenous Prophylaxis Rat model I.V imipenem or ciprofloxacin reduce infections and death, also possible role of SD. Humans retrospective, 180 pts mortality infection no prophylaxis 16% 76% I.V imipenem 5 % 27%. Not stat significant. 14 yr study, poor methodology Intravenous Prophylaxis Numerous meta-analysis, conflicting, inconsistent results Concerns regarding increase reporting gram positive and fungal infections in setting of prophylaxis Pubmed Search terms: prophylaxis, antibiotics, severe acute pancreatitis 15 results 9 prospective trials ab’s Early antibiotic treatment in acute necrotising pancreatitis Sainio V, Kemppainen E, et al. Lancet 1995, 346; 663-664 Prospective, RCT Cefuroxime 1.5g tds vs placebo Antibiotics commenced if infection clinically 60 pts with necrotising alcohol induced SAP Mortality decreased with prophylaxis 1 vs 7 deaths All due to decreased UTI’s Problems Not randomised, blinded High rate UTI’s, responsible for difference Controlled clinical trial of pefloxacin vs imipenem in severe acute pancreatitis Bassi C, Falconi M, Talamini G Liver, Pancreas, and Biliary Tract Gastroenterology 1998; 115:15