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Wen Y, Xu L, Zhang D, Sun W, Che Z, Zhao B, Chen Y, Yang Z, Chen E, Ni T, Mao E. Effect of early antibiotic treatment strategy on prognosis of acute pancreatitis. BMC Gastroenterol 2023; 23:431. [PMID: 38066411 PMCID: PMC10709887 DOI: 10.1186/s12876-023-03070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Antibiotic use in the early stages of acute pancreatitis is controversial. The purpose of this study was to investigate the effect of early antibiotic application on the prognosis of acute pancreatitis (AP). MATERIALS AND METHODS Clinical data of patients with primary AP admitted to our emergency ward within 72 hours of onset were retrospectively collected from January 2016 to December 2020. We classified patients with acute pancreatitis according to etiology and disease severity, and compared the differences in hospital stay, laparotomy rate, and in-hospital mortality among AP patients who received different antibiotic treatment strategies within 72 hours of onset. RESULTS A total of 1134 cases were included, with 681 (60.1%) receiving early antibiotic treatment and 453 (39.9%) not receiving it. There were no significant differences in baseline values and outcomes between the two groups. In subgroup analysis, patients with biliary severe acute pancreatitis (SAP) who received early antibiotics had lower rates of laparotomy and invasive mechanical ventilation, as well as shorter hospital stays compared to those who did not receive antibiotics. In logistic regression analysis, the early administration of carbapenem antibiotics in biliary SAP patients was associated with a lower in-hospital mortality rate. Early antibiotic use in biliary moderate-severe acute pancreatitis (MSAP) reduced hospital stays and in-hospital mortality. Quinolone combined with metronidazole treatment in biliary mild acute pancreatitis (MAP) shortened hospital stays. Early antibiotic use does not benefit patients with non-biliary AP. CONCLUSION Strategies for antibiotic use in the early stages of AP need to be stratified according to cause and disease severity.
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Affiliation(s)
- Yi Wen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Xu
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dayi Zhang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenwu Sun
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zaiqian Che
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing Zhao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhitao Yang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Erzhen Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tongtian Ni
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Enqiang Mao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Management of Common Postoperative Infections in the Surgical Intensive Care Unit. Infect Dis Clin North Am 2022; 36:839-859. [DOI: 10.1016/j.idc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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3
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Napolitano LM. Intra-abdominal Infections. Semin Respir Crit Care Med 2022; 43:10-27. [PMID: 35172355 DOI: 10.1055/s-0041-1741053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Intra-abdominal infections (IAIs) are a common cause of sepsis, and frequently occur in intensive care unit (ICU) patients. IAIs include many diagnoses, including peritonitis, cholangitis, diverticulitis, pancreatitis, abdominal abscess, intestinal perforation, abdominal trauma, and pelvic inflammatory disease. IAIs are the second most common cause of infectious morbidity and mortality in the ICU after pneumonia. IAIs are also the second most common cause of sepsis in critically ill patients, and affect approximately 5% of ICU patients. Mortality with IAI in ICU patients ranges from 5 to 50%, with the wide variability related to the specific IAI present, associated patient comorbidities, severity of illness, and organ dysfunction and failures. It is important to have a comprehensive understanding of IAIs as potential causes of life-threatening infections in ICU patients to provide the best diagnostic and therapeutic care for optimal patient outcomes in the ICU.
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He L, Sun Y. Advances in research of early use of prophylactic antibiotics in severe acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2021; 29:609-614. [DOI: 10.11569/wcjd.v29.i11.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Severe acute pancreatitis (SAP) is a common critical digestive system disease with high mortality, which can lead to multiple organ failure. SAP is often accompanied by massive necrosis of the pancreas, which is prone to secondary infection. Infected pancreatic necrosis is associated with an increased mortality of SAP. Whether early prophylactic use of antibiotics in the treatment of SAP can reduce the incidence of secondary infection is still controversial. This paper reviews the research progress of prophylactic use of antibiotics in the treatment of secondary infection of SAP in recent years.
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Affiliation(s)
- Lin He
- Department of Critical Care Medicine, the Second Affiliated Hospital, Hefei 230601, Anhui Province, China
| | - Yun Sun
- Department of Critical Care Medicine, the Second Affiliated Hospital, Hefei 230601, Anhui Province, China
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Velásquez-Cuasquen BG, Ruiz Beltrán GH, Orozco-Chamorro CM, Díaz Realpe JE, Jiménez Ramírez LJ, Alejandro Fernández DA, Merchán-Galvis Á. Evaluación y análisis del índice de severidad tomográfico y clasificación de Atlanta 2012 en pancreatitis aguda severa. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. En el paciente con pancreatitis aguda severa, la presencia de necrosis infectada y falla multiorgánica se asocian con una mortalidad del 20-40 %. La tomografía computarizada con contraste intravenoso y la clasificación del Consenso de Atlanta 2012 son importantes herramientas de diagnóstico para el tratamiento oportuno. En esta investigación, se analizó la relación del índice de severidad tomográfico y los cambios morfológicos locales según dicha clasificación, con la estancia hospitalaria, intervención, infección y mortalidad de los pacientes.
Métodos. Estudio de cohorte retrospectiva realizado entre los años 2015 y 2019, donde se incluyeron pacientes mayores de 15 años con pancreatitis aguda severa diagnosticado por tomografía computarizada con contraste, y se evaluó el índice de severidad tomográfico y los cambios morfológicos según la clasificación de Atlanta 2012, en relación con los desenlaces clínicos de los pacientes.
Resultados. Se incluyeron 56 pacientes, en el 82,1 % (n=46) de los casos la causa fue litiásica. La falla orgánica fue principalmente pulmonar 53,6 % (n=30) y cardiovascular 55,4 % (n=31). Según la tomografía, se clasificó como severa (7-10 puntos) en el 91,1 % (n=51) de los pacientes. En pacientes con necrosis amurallada infectada la estancia hospitalaria media fue mayor (78,5 días); en todos los pacientes con pancreatitis severa se encontró infección y fueron sometidos a algún tipo de intervención. La mortalidad fue menor del 10 % (n=5).
Discusión. El índice de severidad tomográfica para la categorización de severo se correlacionó en un 90 % con pancreatitis aguda severa. Una tomografía de control a la cuarta semana podría identificar complicaciones tardías para un manejo precoz.
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Extrapancreatic infections are common in acute pancreatitis and they are related to organ failure: a population-based study. Eur J Gastroenterol Hepatol 2020; 32:1293-1300. [PMID: 32675778 DOI: 10.1097/meg.0000000000001847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although the impact of pancreatic infections in acute pancreatitis has been studied extensively, there are no population-based data on extrapancreatic infections and their potential relation to organ failure. We aimed to study the occurrence of pancreatic and extrapancreatic bacterial infections in acute pancreatitis and their relation to patient outcome. PATIENTS AND METHODS All patients with first-time acute pancreatitis from 2003 to 2012 in a defined area in Sweden were retrospectively evaluated. Data on acute pancreatitis severity, organ failure, infections, and in-hospital mortality were collected. RESULTS Overall, 304 bacterial infections occurred in 248/1457 patients (17%). Fifteen percent had extrapancreatic and 2% had pancreatic infections. The lungs (35%), the urinary tract (24%), and the bile ducts (18%) were the most common sites of extrapancreatic infections. Organ failure, severe acute pancreatitis, and in-hospital mortality were more common in patients with vs those without (pancreatic/extrapancreatic) infections (P < 0.05). Organ failure and severe acute pancreatitis occurred more frequently in pancreatic vs extrapancreatic infections (70% vs 34%, P < 0.001 and 67% vs 28%, P < 0.001), but in-hospital mortality did not differ between the two groups (7.4% vs 6.8%, P = 1.0). Both pancreatic and extrapancreatic infections were independent predictors of organ failure (P < 0.05). Out of culture-positive infections, 18% were due to antibiotic-resistant bacteria, without any significant difference between extrapancreatic vs pancreatic infections (P > 0.05). About two out of five infections were of nosocomial origin. CONCLUSION Extrapancreatic infections occurred in 15% and pancreatic infections in 2% of patients with first-time acute pancreatitis. Both pancreatic and extrapancreatic infections were independent predictors of organ failure, leading to increased mortality.
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Abstract
Acute pancreatitis is one of the most common gastrointestinal causes for hospitalization. In 15-20% it evolves into severe necrotizing pancreatitis. Recent studies have shown no association between the initiation of antibiotic therapy in acute pancreatitis and severe outcomes such as organ failure, infection of pancreatic necrosis, extrapancreatic infections or mortality. Specific subgroups with predicted severe acute pancreatitis or both extensive sterile necrosis and persistent organ failure may benefit from prophylactic antibiotics. Local infection develops in 30% of patients with pancreatic necrosis and results in morbidity and mortality. Contrast enhanced computed tomography should be performed in all patients with acute pancreatitis who develop sepsis, organ failure or fail to improve. C-reactive protein is an independent predictor of severe acute pancreatitis. Procalcitonin is the most sensitive laboratory test for detection of pancreatic infection. Antibiotics do however play a large role in patients with suspected or confirmed infected pancreatic necrosis and extrapancreatic infections. In clinical practice most clinicians prescribe antibiotics in the first 3 days of acute pancreatitis which in turns lead to excessive, unjustified use of antibiotics. Deep knowledge of the recent guidelines combined with an individualized management based on right clinical judgment is a rationale approach of patients with acute pancreatitis.
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Affiliation(s)
- Vasiliki Soulountsi
- 1st Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece
| | - Theodoros Schizodimos
- 2nd Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece
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Garret C, Canet E, Corvec S, Boutoille D, Péron M, Archambeaud I, Le Thuaut A, Lascarrou JB, Douane F, Lerhun M, Regenet N, Coron E, Reignier J. Impact of prior antibiotics on infected pancreatic necrosis microbiology in ICU patients: a retrospective cohort study. Ann Intensive Care 2020; 10:82. [PMID: 32542577 PMCID: PMC7295875 DOI: 10.1186/s13613-020-00698-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
Background Recent guidelines advise against prophylactic antibiotics in patients with necrotizing pancreatitis, advocating instead a step-up drainage and necrosectomy strategy with antibiotics as dictated by microbiological findings. However, prompt antibiotic therapy is recommended in patients with sepsis or septic shock, a possible presentation of infected pancreatic necrosis (IPN). Consequently, in many critically ill patients with IPN, pancreatic samples are collected only after broad-spectrum antibiotic therapy initiation. Whether this prior antibiotic exposure alters the microbiological findings is unknown. The main objective was to determine whether prior antibiotic exposure sterilized the samples collected during procedures for suspected IPN in patients admitted to the intensive care unit (ICU) for acute pancreatitis with suspected IPN. We retrospectively studied 56 consecutive ICU patients admitted with suspected IPN. We collected details on the microbiological samples and antimicrobials used. A definite diagnosis of IPN was given when bacteria were identified in pancreatic samples. Results In all, 137 pancreatic samples were collected, including 91 (66.4%) after antibiotic therapy initiation. IPN was confirmed in 48 (86%) patients. The proportion of positive samples was 74 (81.3%) in antibiotic-exposed patients and 32/46 (69.5%) in unexposed patients (p = 0.58). Of the 74 positive samples from exposed patients, 62 (84%) had organisms susceptible to the antibiotics used. One-third of samples contained more than one organism. Among patients with IPN, 37.5% had positive blood cultures. Multidrug- or extensively drug-resistant bacteria were identified at some point in half the patients. Enterobacter cloacae complex was more frequent in the exposed group (p = 0.02), as were Gram-negative anaerobic bacteria (p = 0.03). Conclusion Antibiotic exposure before sampling did not seem to affect culture positivity of pancreatic samples to confirm IPN, but may affect microbiological findings. Our results suggest that, in patients with sepsis and suspected IPN, antibiotics should be started immediately and pancreatic samples obtained as soon as possible thereafter. In other situations, antibiotics can be withheld until the microbiological results of pancreatic samples are available, to ensure accurate targeting of the spectrum to bacterial susceptibility patterns. ClinicalTrials.gov number NCT03253861
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Affiliation(s)
- Charlotte Garret
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France.
| | - Emmanuel Canet
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Stéphane Corvec
- Service de Bactériologie-Hygiène Hospitalière, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | | | - Matthieu Péron
- Service de Maladies Infectieuses et Tropicales, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Isabelle Archambeaud
- Service de Maladies Infectieuses et Tropicales, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Aurélie Le Thuaut
- Institut des Maladies de l'appareil Digestif, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Frédéric Douane
- Département de Biostatistiques, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Marc Lerhun
- Service de Maladies Infectieuses et Tropicales, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Nicolas Regenet
- Service de Maladies Infectieuses et Tropicales, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Emmanuel Coron
- Service de Maladies Infectieuses et Tropicales, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Jean Reignier
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
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Montravers P, Kantor E, Constantin JM, Lefrant JY, Lescot T, Nesseler N, Paugam C, Jabaudon M, Dupont H. Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study. Crit Care 2019; 23:393. [PMID: 31805988 PMCID: PMC6896276 DOI: 10.1186/s13054-019-2681-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 11/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recent international guidelines for acute pancreatitis (AP) recommend limiting anti-infective therapy (AIT) to cases of suspected necrotizing AP or nosocomial extrapancreatic infection. Limited data are available concerning empirical and documented AIT prescribing practices in patients admitted to the intensive care unit (ICU) for the management of AP. METHODS Using a multicentre, retrospective (2009-2014), observational database of ICU patients admitted for AP, our primary objective was to assess the incidence of AIT prescribing practices during the first 30 days following admission. Secondary objectives were to assess the independent impact of centre characteristics on the incidence of AIT and to identify factors associated with crude hospital mortality in a logistic regression model. RESULTS In this cohort of 860 patients, 359 (42%) received AIT on admission. Before day 30, 340/359 (95%) AIT patients and 226/501 (45%) AIT-free patients on admission received additional AIT, mainly for intra-abdominal and lung infections. A large heterogeneity was observed between centres in terms of the incidence of infections, therapeutic management including AIT and prognosis. Administration of AIT on admission or until day 30 was not associated with an increased mortality rate. Patients receiving AIT on admission had increased rates of complications (septic shock, intra-abdominal and pulmonary infections), therapeutic (surgical, percutaneous, endoscopic) interventions and increased length of ICU stay compared to AIT-free patients. Patients receiving delayed AIT after admission and until day 30 had increased rates of complications (respiratory distress syndrome, intra-abdominal and pulmonary infections), therapeutic interventions and increased length of ICU stay compared to those receiving AIT on admission. Risk factors for hospital mortality assessed on admission were age (adjusted odds ratio [95% confidence interval] 1.03 [1.02-1.05]; p < 0.0001), Balthazar score E (2.26 [1.43-3.56]; p < 0.0001), oliguria/anuria (2.18 [1.82-4.33]; p < 0.0001), vasoactive support (2.83 [1.73-4.62]; p < 0.0001) and mechanical ventilation (1.90 [1.15-3.14]; p = 0.011), but not AIT (0.63 [0.40-1.01]; p = 0.057). CONCLUSIONS High proportions of ICU patients admitted for AP receive AIT, both on admission and during their ICU stay. A large heterogeneity was observed between centres in terms of incidence of infections, AIT prescribing practices, therapeutic management and outcome. AIT reflects the initial severity and complications of AP, but is not a risk factor for death.
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Affiliation(s)
- Philippe Montravers
- Département d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, HUPNVS, APHP, 48 rue Henri Huchard, F-75018, Paris, France.
- Université de Paris, Paris, France.
- INSERM UMR 1152 - Université de Paris, Paris, France.
| | - Elie Kantor
- Département d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, HUPNVS, APHP, 48 rue Henri Huchard, F-75018, Paris, France
- Université de Paris, Paris, France
| | - Jean-Michel Constantin
- Département de Médecine Post-opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France
| | - Jean-Yves Lefrant
- Division of Anaesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, and EA 2992, Université Montpellier, Nîmes, France
| | - Thomas Lescot
- Department of Anaesthesia and Critical Care, Saint-Antoine University Hospital, Assistance Publique-Hôpitaux de Paris, and Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Nicolas Nesseler
- Surgical Intensive Care Unit, Hôpital Pontchaillou, and Inserm U 991, Université de Rennes 1, Rennes, France
| | - Catherine Paugam
- Université de Paris, Paris, France
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Jabaudon
- Département de Médecine Post-opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France
| | - Hervé Dupont
- Medical and Surgical ICU, Amiens University Hospital and INSERM U1088, University of Picardy Jules Verne, Amiens, France
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Cen ME, Wang F, Su Y, Zhang WJ, Sun B, Wang G. Gastrointestinal microecology: a crucial and potential target in acute pancreatitis. Apoptosis 2019; 23:377-387. [PMID: 29926313 DOI: 10.1007/s10495-018-1464-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the early stage of acute pancreatitis (AP), abundant cytokines induced by local pancreatic inflammation enter the bloodstream, further cause systemic inflammatory response syndrome (SIRS) by "trigger effect", which eventually leads to multiple organ dysfunction syndrome (MODS). During SIRS and MODS, the intestinal barrier function was seriously damaged accompanied by the occurrence of gut-derived infection which forms a "second hit summit" by inflammatory overabundance. Gastrointestinal microecology, namely the biologic barrier, could be transformed into a pathogenic state, which is called microflora dysbiosis when interfered by the inflammatory stress during AP. More and more evidences indicate that gastrointestinal microflora dysbiosis plays a key role in "the second hit" induced by AP gut-derived infection. Therefore, the maintenance of gastrointestinal microecology balance is likely to provide an effective method in modulating systemic infection of AP. This article reviewed the progress of gastrointestinal microecology in AP to provide a reference for deeply understanding the pathogenic mechanisms of AP and identifying new therapeutic targets.
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Affiliation(s)
- Meng-Er Cen
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang, China.,Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China
| | - Feng Wang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ying Su
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Wang-Jun Zhang
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang, China
| | - Bei Sun
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang, China
| | - Gang Wang
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang, China.
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Wolbrink DRJ, Kolwijck E, Ten Oever J, Horvath KD, Bouwense SAW, Schouten JA. Management of infected pancreatic necrosis in the intensive care unit: a narrative review. Clin Microbiol Infect 2019; 26:18-25. [PMID: 31238118 DOI: 10.1016/j.cmi.2019.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Severe acute pancreatitis is marked by organ failure and (peri)pancreatic necrosis with local complications such as infected necrosis. Infection of these necrotic collections together with organ failure remain the major causes of admission to an intensive care unit (ICU) in acute pancreatitis. Appropriate treatment of infected necrosis is essential to reduce morbidity and mortality. Overall knowledge of the treatment options within a multidisciplinary team-with special attention to the appropriate use of antimicrobial therapy and invasive treatment techniques for source control-is essential in the treatment of this complex disease. OBJECTIVES To address the current state of microbiological diagnosis, antimicrobial treatment, and source control for infected pancreatic necrosis in the ICU. SOURCES A literature search was performed using the Medline and Cochrane libraries for articles subsequent to 2003 using the keywords: infected necrosis, pancreatitis, intensive care medicine, treatment, diagnosis and antibiotic(s). CONTENT This narrative review provides an overview of key elements of diagnosis and treatment of infected pancreatic necrosis in the ICU. IMPLICATIONS In pancreatic necrosis it is essential to continuously (re)evaluate the indication for antimicrobial treatment and invasive source control. Invasive diagnostics (e.g. through fine-needle aspiration, FNA), preferably prior to the start of broad-spectrum antimicrobial therapy, is advocated. Antimicrobial stewardship principles apply: paying attention to altered pharmacokinetics in the critically ill, de-escalation of broad-spectrum therapy once cultures become available, and early withdrawal of antibiotics once source control has been established. This is important to prevent the development of antimicrobial resistance, especially in a group of patients who may require repeated courses of antibiotics during the prolonged course of their illness.
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Affiliation(s)
- D R J Wolbrink
- Radboud University Medical Centre, Department of Surgery, Nijmegen, the Netherlands; Dutch Pancreatitis Study Group, the Netherlands(†)
| | - E Kolwijck
- Radboud Centre for Infectious Diseases, Department of Medical Microbiology, Nijmegen, the Netherlands
| | - J Ten Oever
- Radboud Centre for Infectious Diseases, Department of Internal Medicine, Nijmegen, the Netherlands
| | - K D Horvath
- University of Washington, Department of Surgery, Seattle, WA 98195, USA
| | - S A W Bouwense
- Radboud University Medical Centre, Department of Surgery, Nijmegen, the Netherlands; Dutch Pancreatitis Study Group, the Netherlands(†)
| | - J A Schouten
- Radboud Centre for Infectious Diseases, Department of Intensive Care, Nijmegen, the Netherlands.
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Effects of High-Flow Nasal Cannula on the Work of Breathing in Patients Recovering From Acute Respiratory Failure*. Crit Care Med 2017; 45:1981-1988. [DOI: 10.1097/ccm.0000000000002693] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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13
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Ignatavicius P, Gulla A, Cernauskis K, Barauskas G, Dambrauskas Z. How severe is moderately severe acute pancreatitis? Clinical validation of revised 2012 Atlanta Classification. World J Gastroenterol 2017; 23:7785-7790. [PMID: 29209119 PMCID: PMC5703938 DOI: 10.3748/wjg.v23.i43.7785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/01/2017] [Accepted: 11/01/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the outcomes and the appropriate treatment for patients with moderately severe acute pancreatitis (AP).
METHODS Statistical analysis was performed on data from the prospectively collected database of 103 AP patients admitted to the Department of Surgery, Hospital of Lithuanian University of Health Sciences in 2008-2013. All patients were confirmed to have the diagnosis of AP during the first 24 h following admission. The severity of pancreatitis was assessed by MODS and APACHE II scale. Clinical course was re-evaluated after 24, 48 and 72 h. All patients were categorized into 3 groups based on Atlanta 2012 classification: Mild, moderately severe, and severe. Outcomes and management in moderately severe group were also compared to mild and severe cases according to Atlanta 1992 and 2012 classification.
RESULTS Fifty-three-point four percent of patients had edematous while 46.6 % were diagnosed with necrotic AP. The most common cause of AP was alcohol (42.7%) followed by alimentary (26.2%), biliary (26.2%) and idiopathic (4.9%). Under Atlanta 1992 classification 56 (54.4%) cases were classified as “mild” and 47 (45.6%) as “severe”. Using the revised classification (Atlanta 2012), the patient stratification was different: 49 (47.6%) mild, 27 (26.2%) moderately severe and 27 (26.2%) severe AP cases. The two severe groups (Atlanta 1992 and Revised Atlanta 2012) did not show statistically significant differences in clinical parameters, including ICU stay, need for interventional treatment, infected pancreatic necrosis or mortality rates. The moderately severe group of 27 patients (according to Atlanta 2012) had significantly better outcomes when compared to those 47 patients classified as severe form of AP (according to Atlanta 1992) with lower incidence of necrosis and sepsis, lower APACHE II (P = 0.002) and MODS (P = 0.001) scores, shorter ICU stay, decreased need for interventional and surgical treatment.
CONCLUSION Study shows that Atlanta 2012 criteria are more accurate, reduce unnecessary treatments for patients with mild and moderate severe pancreatitis, potentially resulting in health costs savings.
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Affiliation(s)
- Povilas Ignatavicius
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
| | - Aiste Gulla
- Department of Surgery, Georgetown University Hospital, Reservoir 3800, Washington, DC 20007, United States
- Department of Surgery, Division of Vascular Surgery, Vilnius University, Santariskiu Clinics, Vilnius 08661, Lithuania
| | - Karolis Cernauskis
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
| | - Giedrius Barauskas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
| | - Zilvinas Dambrauskas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
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14
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Collapse of the Microbiome, Emergence of the Pathobiome, and the Immunopathology of Sepsis. Crit Care Med 2017; 45:337-347. [PMID: 28098630 DOI: 10.1097/ccm.0000000000002172] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The definition of sepsis has been recently modified to accommodate emerging knowledge in the field, while at the same time being recognized as challenging, if not impossible, to define. Here, we seek to clarify the current understanding of sepsis as one that has been typically framed as a disorder of inflammation to one in which the competing interests of the microbiota, pathobiota, and host immune cells lead to loss of resilience and nonresolving organ dysfunction. Here, we challenge the existence of the idea of noninfectious sepsis given that critically ill humans never exist in a germ-free state. Finally, we propose a new vision of the pathophysiology of sepsis that includes the invariable loss of the host's microbiome with the emergence of a pathobiome consisting of both "healthcare-acquired and healthcare-adapted pathobiota." Under this framework, the critically ill patient is viewed as a host colonized by pathobiota dynamically expressing emergent properties which drive, and are driven by, a pathoadaptive immune response.
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Pintado MC, Trascasa M, Arenillas C, de Zárate YO, Pardo A, Blandino Ortiz A, de Pablo R. New Atlanta Classification of acute pancreatitis in intensive care unit: Complications and prognosis. Eur J Intern Med 2016; 30:82-87. [PMID: 26803217 DOI: 10.1016/j.ejim.2016.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The updated Atlanta Classification of acute pancreatitis (AP) in adults defined three levels of severity according to the presence of local and/or systemic complications and presence and length of organ failure. No study focused on complications and mortality of patients with moderately severe AP admitted to intensive care unit (ICU). The main aim of this study is to describe the complications developed and outcomes of these patients and compare them to those with severe AP. METHODS Prospective, observational study. We included patients with acute moderately severe or severe AP admitted in a medical-surgical ICU during 5years. We collected demographic data, admission criteria, pancreatitis etiology, severity of illness, presence of organ failure, local and systemic complications, ICU length of stay, and mortality. RESULTS Fifty-six patients were included: 12 with moderately severe AP and 44 with severe. All patients developed some kind of complications without differences on complications rate between moderately severe or severe AP. All the patients present non-infectious systemic complications, mainly acute respiratory failure and hemodynamic failure. 82.1% had an infectious complication, mainly non-pancreatic infection (66.7% on moderately severe AP vs. 79.5% on severe, p=0.0443). None of the patients with moderately severe AP died during their intensive care unit stay vs. 29.5% with severe AP (p=0.049). CONCLUSIONS Moderately severe AP has a high rate of complications with similar rates to patients with severe AP admitted to ICU. However, their ICU mortality remains very low, which supports the existence of this new group of pancreatitis according to their severity.
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Affiliation(s)
- María-Consuelo Pintado
- Intensive Care Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain; University of Alcalá, Alcalá de Henares, Madrid, Spain.
| | - María Trascasa
- Intensive Care Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Cristina Arenillas
- Intensive Care Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Yaiza Ortiz de Zárate
- Intensive Care Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Ana Pardo
- Intensive Care Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Aaron Blandino Ortiz
- Intensive Care Unit, Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain
| | - Raúl de Pablo
- Intensive Care Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain; University of Alcalá, Alcalá de Henares, Madrid, Spain
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Russell PS, Mittal A, Brown L, McArthur C, Phillips AJR, Petrov M, Windsor JA. Admission, management and outcomes of acute pancreatitis in intensive care. ANZ J Surg 2016; 87:E266-E270. [PMID: 27018076 DOI: 10.1111/ans.13498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/09/2016] [Accepted: 01/19/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND A review of the management of acute pancreatitis (AP) at a tertiary intensive care unit (ICU) in Auckland, New Zealand, was published in 2004. This paper aims to update this series and identify changes in admission criteria, management and outcomes. METHODS A retrospective review of patients admitted to the Department of Critical Care Medicine, Auckland City Hospital, with AP from 2003 to 2014 was undertaken and data compared with the previous study (1988-2001). RESULTS Eighty-four patients (male 53, mean ± SD age = 56.9 ± 15 years) with 85 admissions to ICU from 2003 to 2014 were compared with 112 patients in the previous study. Maori were over-represented. Median duration of symptoms prior to admission to ICU decreased from 7 to 3 days. The proportion of total AP patients admitted to ICU halved and the mean Acute Physiology and Chronic Health Evaluation II score on admission decreased from mean 19.9 ± 8.2 SD to 15.4 ± 7.3 (P < 0.001). Two thirds of patients had persistent organ failure. The use of enteral feeding doubled from 46/112 (41%) to 71/85 (84%) (P < 0.001). The use of primary percutaneous drainage increased from 14/112 (13%) to 24/85 (28%) (P = 0.007). Rate of necrosectomy was similar (36/112 (32%) versus 20/85 (24%), P = 0.205), although minimally invasive necrosectomy was introduced. Overall hospital mortality decreased by 29% (P = 0.198). CONCLUSION There have been changes to the admission criteria and management in line with evolving guidelines and, overall, outcomes have improved.
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Affiliation(s)
- Peter S Russell
- Department of General Surgery, North Shore Hospital, North Shore City, New Zealand
| | - Anhubav Mittal
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Lisa Brown
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Colin McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | | | - Max Petrov
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - John A Windsor
- Department of Surgery, University of Auckland, Auckland, New Zealand
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17
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Keane MG, Sze SF, Cieplik N, Murray S, Johnson GJ, Webster GJ, Thorburn D, Pereira SP. Endoscopic versus percutaneous drainage of symptomatic pancreatic fluid collections: a 14-year experience from a tertiary hepatobiliary centre. Surg Endosc 2015; 30:3730-40. [PMID: 26675934 PMCID: PMC4992018 DOI: 10.1007/s00464-015-4668-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/14/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Endoscopic transmural drainage (ED) or percutaneous drainage (PD) has mostly replaced surgery for the initial management of patients with symptomatic pancreatic fluid collections (PFCs). This study aimed to compare outcomes for patients undergoing ED or PD of symptomatic PFCs. METHODS Between January 2000 and December 2013, all patients who required PD or ED of a PFC were included. Rates of treatment success, length of hospital stay, adverse events, re-interventions and length of follow-up were recorded retrospectively in all cases. RESULTS In total, 164 patients were included in the study; 109 patients underwent ED; and 55 had PD alone. During the 14-year study period, the incidence of ED increased and PD fell. In the 109 patients who were managed by ED, treatment success was considerably higher than in those managed by PD (70 vs. 31 %). Rates of procedural adverse events were higher in the ED cohort compared to the PD group (10 vs. 1 %), but patients managed by ED required fewer interventions (median of 1.8 vs. 3.3) had lower rates of residual collections (21 vs. 67 %) and need for surgical intervention (4 vs. 11 %). In the ED group, treatment success was similar for walled-off pancreatic necrosis (WOPN) and pseudocysts (67 vs. 72 %, P = 0.77). There were no procedure-related deaths. CONCLUSION Compared with PD, ED of symptomatic PFCs was associated with higher rates of treatment success, lower rates of re-intervention, including surgery and shorter lengths of hospital stay. Outcomes in WOPN were comparable to those in patients with pseudocysts.
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Affiliation(s)
- Margaret G Keane
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK.
| | - Shun Fung Sze
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK
| | - Natascha Cieplik
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK
| | - Sam Murray
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BG, UK
| | - Gavin J Johnson
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BG, UK
| | - George J Webster
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BG, UK
| | - Douglas Thorburn
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK
| | - Stephen P Pereira
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK.
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Alimujiang•Abulimiti, Aierhati•Husaiyin, Yalikun•Sailai. Correlation of high sensitivity C-reactive protein, neutrophil and lymphocyte ratio and extra-pancreatic inflammation on CT score with disease severity in alcoholic acute pancreatitis patients. Shijie Huaren Xiaohua Zazhi 2015; 23:5388-5393. [DOI: 10.11569/wcjd.v23.i33.5388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the correlation of serum high sensitivity C-reactive protein (hs-CRP) level, neutrophil and lymphocyte ratio (NLR) and extra-pancreatic inflammation on CT (EPIC) score with disease severity in alcoholic acute pancreatitis (AAP) patients.
METHODS: One hundred and six patients with acute pancreatitis (AP) treated at our hospital from April 2013 to April 2014, including 44 patients with AAP as an observation group, and 62 patients without AAP as a control group, were included in this study. All patients received blood tests and abdominal CT examination within 24 h of admission to hospital. Serum hs-CRP levels, NLR and EPIC score were compared between the two groups to explore the relationship between these indexes and AAP illness severity.
RESULTS: The proportion of male patients, proportion of SAP patients, serum hs-CRP levels, NLR and EPIC score were significantly higher, but the age was significantly younger in the observation group than in the control group (P < 0.05 for all). In the observation group, SAP patients had significantly higher serum hs-CRP levels (65.45 mg/L ± 15.43 mg/L vs 42.13 mg/L ± 13.76 mg/L), NLR (14.64 ± 4.65 vs 7.12 ± 2.75) and EPIC score (4.23 ± 0.54 vs 1.72 ± 1.72) than those with mild acute pancreatitis (t = 2.652, 2.903, and 2.886, P < 0.05). Spearman correlation analysis showed that serum hs-CRP levels, NLR and EPIC were significantly correlated with the AAP severity (r = 0.539, 0.626, and 0.507, P < 0.05).
CONCLUSION: AAP tends to occur in young and middle-aged men and is associated with a higher incidence of SAP. Serum hs-CRP levels, NLR and EPIC score are significantly higher in AAP patients than in non-AAP patients. Serum hs-CRP levels, NLR and EPIC score can be used as effective indexes for evaluating the severity of AAP.
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Rosenberg A, Steensma EA, Napolitano LM. Necrotizing pancreatitis: new definitions and a new era in surgical management. Surg Infect (Larchmt) 2015; 16:1-13. [PMID: 25761075 DOI: 10.1089/sur.2014.123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Necrotizing pancreatitis is a challenging condition that requires surgical treatment commonly and is associated with substantial morbidity and mortality. Over the past decade, new definitions have been developed for standardization of severity of acute and necrotizing pancreatitis, and new management techniques have emerged based on prospective, randomized clinical trials. METHODS Review of English-language literature. RESULTS A new international classification of acute pancreatitis has been developed by PANCREA (Pancreatitis Across Nations Clinical Research and Education Alliance) to replace the Atlanta Classification. It is based on the actual local (whether pancreatic necrosis is present or not, whether it is sterile or infected) and systemic determinants (whether organ failure is present or not, whether it is transient or persistent) of severity. Early management requires goal-directed fluid resuscitation (with avoidance of over-resuscitation and abdominal compartment syndrome), assessment of severity of pancreatitis, diagnostic computed tomography (CT) imaging to assess for necrotizing pancreatitis, consideration of endoscopic retrograde cholangiopancreatography (ERCP) for biliary pancreatitis and early enteral nutrition support. Antibiotic prophylaxis is not recommended. Therapeutic antibiotics are required for treatment of documented infected pancreatic necrosis. The initial treatment of infected pancreatic necrosis is percutaneous catheter or endoscopic (transgastric/transduodenal) drainage with a second drain placement as required. Lack of clinical improvement after these initial procedures warrants consideration of minimally invasive techniques for pancreatic necrosectomy including video-assisted retroperitoneal debridement (VARD), minimally invasive retroperitoneal pancreatectomy (MIRP), or transluminal direct endoscopic necrosectomy (DEN). Open necrosectomy is associated with substantial morbidity, but to date no randomized trial has documented superiority of either minimally invasive or open surgical technique. Additional trials are underway to address this. CONCLUSIONS Severe acute and necrotizing pancreatitis requires a multi-disciplinary treatment strategy that must be individualized for each patient. Optimal treatment of necrotizing pancreatitis now requires a staged, multi-disciplinary, minimally invasive "step-up" approach that includes a team of interventional radiologists, therapeutic endoscopists, and surgeons.
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Affiliation(s)
- Andrew Rosenberg
- Division of Acute Care Surgery [Trauma, Burn, Surgical Critical Care, Emergency Surgery], Department of Surgery, University of Michigan Medical Center , Ann Arbor, Michigan
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Zhu YM, Lin S, Dang XW, Wang M, Li L, Sun RQ, Chen XY. Effects of probiotics in treatment of severe acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2014; 22:5013-5017. [DOI: 10.11569/wcjd.v22.i32.5013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effects of probiotics in the treatment of severe acute pancreatitis (SAP).
METHODS: Thirty-nine SAP patients were randomly divided into two groups: a control group and a treatment group. The treatment group was given probiotics through the nasointestinal feeding tube, and the control group was given placebo (starch preparations). Infectious complications (including infected necrosis of the pancreas, pneumonia, urosepsis and bacteraemia), duration of intensive care, and rates of percutaneous drainage, intestinal ischemia and necrosis were compared between the two groups.
RESULTS: There was no significant difference (P > 0.05) in infectious complications, duration of intensive care or the rate of percutaneous drainage between the two groups, but the rate of intestinal ischemia and necrosis was significantly higher in the treatment group than in the control group.
CONCLUSION: Using probiotics does not reduce infectious complications, shorten the duration of intensive care, or reduce the rate of percutaneous drainage in patients with SAP, but increase the rate of intestinal ischemia and necrosis.
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