Prevention of infectious complications in predicted severe acute pancreatitis (SAP)-a single center randomized controlled trial

INTRODUCTION:

It's mostly accepted there's no need for routine antibiotic prophylaxis in mild cases of AP. Evidence of prevention of infectious complications in SAP is still controversial with imipenem showing potential benefit. Aims: To investigate prophylactic use of imipenem for prevention of infectious complications in predicted SAP.

PATIENTS & METHODS:

Consecutive AP patients with APACHE II
8 were randomly assigned in a double-blind manner to receive imipenem 3x500 mg i.v. daily or an identical placebo ideally for ten days. Infectious complications including infected pancreatic necrosis, pneumonia, urinary tract infection (UTI), positive blood cultures, sepsis, and other infections were determined as the primary outcome. Exclusion criteria were prior AP, chronic pancreatitis, active malignancy, immune deficiency, active infection, concomitant antibiotic treatment within 72 hours before enrollment, pregnant and breasfeeding women, and patients <18 years. Concomitant treatment was given equally in both groups.

RESULTS:

A total of 98 patients were randomized, 49 to each group. Patients were similar according to demographics and average disease severity scores. Infective complications were present in 10/49 versus 12/49 patients (P¼0, 81). There was no significant difference in specific infective complications: infective pancreatic necrosis (3/49 vs. 2/49), pneumonia (3/ 49 vs. 2/49), UTI (3/49 vs. 5/49), positive blood cultures (1/49 vs. 3/49), sepsis (1/49 vs. 2/49), and other (4/49 vs. 3/49), respectively. We found no significant differences in mortality (P¼1, 00), organ failure (P¼0, 39), and local complications (P¼0, 31). Occurrence of mycotic infections was similar in both groups.

CONCLUSION:

Our results add to available evidence there's currently no ground to support routine prophylactic use of antibiotics in pedicted SAP.