抗生素PPT课件（英文精品）Infection in acute .pptVIP

Infection in acute pancreatitis Acute pancreatitis: Interstitial: 80% Necrotizing: 20% Infection dependent on - necrosis Duration 1 – 2 weeks 50% 3 weeks 71% Pancreatic abscess 4 weeks Parameters for diagnosing pancreatic necrosis 1. Ranson’s score 3 48 hours 2. Apache II illness grading system 10 3. C-reactive protein 120 mg/L 4. Lactate dehydrogenase 270 mg/L 5. Interleukin – 6 Poor accuracy in predicting severity 6. CECT – Gold standard 48 hours – high comparability overall accuracy – 95% 50 Hounsfield Unit – Nonperfused mortality morbidity No Necrosis 0% 6% Necrosis 23% 82% Air in pancreas/peripancreatic space – infection Pancreatic Infection * unresolved organ failure * persisting systemic toxicity – high fever, ? TLC * low grade fever, 15000 cells US/CT guided FNA necrosis + fluid collection 20 – 22G needle Gram stain + culture Avoid colon - oral contrast agent Influence of pancreatic infection on morbidity and mortality Bacteriologic findings of infected pancreatitis E coli (35%) Enterococcus (24%) Klebsiella pneumoniae (24%) Pseudomonas (11%) Proteus (8%) Aerobic streptococcus (7%) Enterobacter (7%) Bacteroides (6%) Anaerobes (6%) Fungal – antibiotics for long Monomicrobial 58% Polymicrobial 42% Possible pathways for pancreatic infection Colon – bacterial translocation Lymphatics, Hematogenous, Transmural Antibiotics in pancreatitis Drug concentration pancreas/peripancreatic tissue Efficacy Factor Aminoglycosides Netilmycin 0.14 Tobramycin 0.12 Ureidopenicillins Mezlocillin 0.71 Piperacillin 0.72 Cephalosporins Ceftrizoxime 0.76 Cefotaxime 0.78 Ceftriaxone 0.79 Quinolones Ciprofloxacin 0.86 Ofloxacin 0.87 Carbapenums Imipenum 0.98 Antibiotic prophylaxis in severe acute pancreatitis Unequal distribution of severity of pancreatitis Mortality significantly reduced with prophylactic antib