Conference»23rd United European Gastroenterology Week. Published in: United European Gastroenterology Journal
Year»2015
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Introduction: Infected necrosis is a serious complication of acute pancreatitis leading to a mortality rate of about 40%1. Although prophylactic antibiotics are not recommended, meta-analytic data show that imipenem significantly reduces the rate of infected necrosis1. Aims & Methods: The aim of our study is to evaluate the prophylactic use of imipenem in patients with predicted severe acute pancreatitis. We conducted a prospective randomized trial in a tertiary care setting in Rijeka. Patients with AP and an APACHE II8 were randomized to receive either imipenem 500 mg i.v. three times daily for the first ten days or an identical placebo. Exclusion criteria included age518 years, any infection present at admission, chronic pancreatitis, active malignancy, immunodeficiency, post-surgical patients, pregnant and breastfeeding women and patients unwilling to participate in the study. All patients received early enteral nutrition administered via a nasojejunal tube. Concomitant treatment was similar in both groups. All patients had an abdominal CT scan performed between days 3 to 7, and in cases of clinically suspected infected pancreatic necrosis. Results: Forty-seven consecutive patients were randomized. Twenty-three received imipenem and 24 received placebo. Three patients died in the imipenem group, while two patients died in the placebo group (p=0.667). There were no differences in the occurrence of infected necrosis, with 2 vs. 3 cases, respectively. Other local complications were present in 7 and 13 patients (p=0.142), while persistent organ failure was present in 4 and 5 patients (p=1.00) in the imipenem and placebo group, respectively. Other infection were detected in 2 patients receiving imipenem and 5 patients on placebo(p=0.416). Conclusion: Preliminary data showed no significant beneficial effects of prophylactic imipenem use in patients with predicted severe acute pancreatitis.
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.
OBJECTIVES: This study aimed to investigate the efficiency of imipenem to prevent infectious complications in predicted severe acute pancreatitis (AP).
METHODS: Consecutive AP patients were randomized to imipenem 3 × 500 mg intravenously daily or an identical placebo. Exclusion criteria were prior AP, chronic pancreatitis, active malignancy, immune deficiency, active infection, concomitant antibiotic treatment, pregnancy, and patients younger than 18 years. Infectious complications including infected pancreatic necrosis, pneumonia, urinary tract infection, positive blood cultures, sepsis, and other infections were assessed as the primary outcome. Secondary outcomes included mortality, persistent organ failure, systemic inflammatory response syndrome, local complications, serious adverse events, and need for surgical intervention.
RESULTS: Forty-nine patients were randomized to each group. Infectious complications were present in 10 versus 12 of 49 patients (relative risk [RR], 0.833; 95% confidence interval [CI], 0.398-1.747). There were no significant differences in infected pancreatic necrosis (RR, 1.5; 95% CI, 0.262-8.588), pneumonia (RR, 1.5; 95% CI, 0.262-8.588), urinary tract infection (RR, 0.6; 95% CI, 0.152-2.374), positive blood cultures (RR, 0.5; 95% CI, 0.047-5.336), sepsis (RR, 0.333; 95% CI, 0.036-3.095), and other (RR, 1.333; 95% CI, 0.315-5.648). We found no significant differences in secondary outcomes.
CONCLUSIONS: Concordantly to available evidence, there is currently no ground to support prophylactic use of antibiotics in predicted severe AP.
Introduction: Infected necrosis is a serious complication of acute pancreatitis leading to a mortality rate of about 40%1. Although prophylactic antibiotics are not recommended, meta-analytic data show that imipenem significantly reduces the rate of infected necrosis1. Aims & Methods: The aim of our study is to evaluate the prophylactic use of imipenem in patients with predicted severe acute pancreatitis. We conducted a prospective randomized trial in a tertiary care setting in Rijeka. Patients with AP and an APACHE II8 were randomized to receive either imipenem 500 mg i.v. three times daily for the first ten days or an identical placebo. Exclusion criteria included age518 years, any infection present at admission, chronic pancreatitis, active malignancy, immunodeficiency, post-surgical patients, pregnant and breastfeeding women and patients unwilling to participate in the study. All patients received early enteral nutrition administered via a nasojejunal tube. Concomitant treatment was similar in both groups. All patients had an abdominal CT scan performed between days 3 to 7, and in cases of clinically suspected infected pancreatic necrosis. Results: Forty-seven consecutive patients were randomized. Twenty-three received imipenem and 24 received placebo. Three patients died in the imipenem group, while two patients died in the placebo group (p=0.667). There were no differences in the occurrence of infected necrosis, with 2 vs. 3 cases, respectively. Other local complications were present in 7 and 13 patients (p=0.142), while persistent organ failure was present in 4 and 5 patients (p=1.00) in the imipenem and placebo group, respectively. Other infection were detected in 2 patients receiving imipenem and 5 patients on placebo(p=0.416). Conclusion: Preliminary data showed no significant beneficial effects of prophylactic imipenem use in patients with predicted severe acute pancreatitis.
