Journal of Gastrointestinal Infections

Register      Login

VOLUME 9 , ISSUE 1 ( January-December, 2019 ) > List of Articles

REVIEW ARTICLE

Infections in Acute Pancreatitis: A Review

Keywords : Diagnosis, Infected pancreatic necrosis, Management, Pancreatic infections

Citation Information : Infections in Acute Pancreatitis: A Review. J Gastrointest Infect 2019; 9 (1):28-37.

DOI: 10.5005/jp-journals-10068-3030

License: CC BY-NC 4.0

Published Online: 16-07-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Acute pancreatitis (AP) is an unpredictable disease accounting for more than 50% of all hospital admissions for pancreatic diseases. The disease is generally mild and self-limiting, but about 20% of the patients develop moderate to severe AP with poor prognosis leading to high morbidity and mortality. Recently increased occurrence of AP has been noted with severe AP requiring several weeks to months for treatment. Acute pancreatitis may get complicated by pancreatic and/or peripancreatic necrosis, which may become infected through several routes. The pathogenesis of secondary bacterial pancreatic infection is still under controversy. Acute pancreatitis is the setting for most infections of the pancreas, which can complicate various stages of pancreatitis. In some patients, AP develops into necrotizing pancreatitis. Patients with AP-related infected pancreatic necrosis (IPN) are prone to develop organ failure, leading to increased mortality, further complicated by multidrug-resistant (MDR) microorganisms. The bacterial spectrum in IPN reflects the commensal flora of the intestine. Clinically, there are no reliable parameters to distinguish infected from sterile necrosis as the clinical features are indistinguishable from other infectious conditions. Infected pancreatic necrosis can be diagnosed mainly by laboratory methods like culture and radiographic scan. The management of AP has developed considerably during the past decades. The preferred choices are primary conservative and minimally invasive modalities compared to open surgical necrosectomy. Antibiotics are generally not given to patients with severe AP because of limited clinical benefits. Various aspects of infections of AP inclusive of diagnostic and management modalities have been reviewed here.


HTML PDF Share
  1. Garber A, Frakes C, Arora Z, et al. Mechanisms and management of acute pancreatitis. Gastroenterol Res Pract 2018;2018:6218798. DOI: 10.1155/2018/6218798.
  2. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62(1):102–111. DOI: 10.1136/gutjnl-2012-302779.
  3. NICE guideline. Pancreatitis diagnosis and management. March 2018. Available from: www.nice.org.uk.
  4. van Dijk SM, Hallensleben NDL, van Santvoort HC, et al. Acute pancreatitis: recent advances through randomised trials. Gut 2017;66(11):2024–2032. DOI: 10.1136/gutjnl-2016-313595.
  5. Banks PA, Freeman ML, Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006;101(10):2379–2400. DOI: 10.1111/j.1572-0241.2006.00856.x.
  6. Xiao AY, Tan MLY, Wu LM, et al. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol 2016;1(1):45–55. DOI: 10.1016/S2468-1253(16)30004-8.
  7. Eland IA, Sturkenboom MC, van der Lei J, et al. Incidence and mortality of acute pancreatitis between 1985 and 1995. Scand J Gastroenterol 2000;35(10):1110–1116. DOI: 10.1080/003655200451261.
  8. Frey CF, Zhou H, Harvey DJ, et al. The incidence and case-fatality rates of acute biliary, alcoholic, and idiopathic pancreatitis in California, 1994-2001. Pancreas 2006;33(4):336–344. DOI: 10.1097/01.mpa.0000236727.16370.99.
  9. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013;144(6):1252–1261. DOI: 10.1053/j.gastro.2013.01.068.
  10. Uhl W, Warshaw A, Imriec C, et al. IAP Guidelines for the surgical management of acute pancreatitis. Pancreatology 2002;2(6):565–573. DOI: 10.1159/000067684.
  11. Mourad MM, Evans R, Kalidindi V, et al. Prophylactic antibiotics in acute pancreatitis: endless debate. Ann R Coll Surg Engl 2017;99(2):107–112. DOI: 10.1308/rcsann.2016.0355.
  12. Sarri G, Guo Y, Iheanacho I, et al. Moderately severe and severe acute pancreatitis: a systematic review of the outcomes in the USA and European Union-5. BMJ Open Gastroenterol 2019;6(1):e000248. DOI: 10.1136/bmjgast-2018-000248.
  13. Isenmann R, Rau B, Beger HG. Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis. Br J Surg 1999;86(8):1020–1024. DOI: 10.1046/j.1365-2168.1999.01176.x.
  14. Sharma M, Banerjee D, Garg PK. Characterization of newer subgroups of fulminant and subfulminant pancreatitis associated with a high early mortality. Am J Gastroenterol 2007;102(12):2688–2695. DOI: 10.1111/j.1572-0241.2007.01446.x.
  15. Garg PK, Madan K, Pande GK, et al. Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis. Clin Gastroenterol Hepatol 2005;3(2):159–166. DOI: 10.1016/S1542-3565(04)00665-2.
  16. Petrov MS, Shanbhag S, Chakraborty M, et al. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology 2010;139(3):813–820. DOI: 10.1053/j.gastro.2010.06.010.
  17. Bota S, Sporea I, Sirli R, et al. Predictive factors for severe evolution in acute pancreatitis and a new score for predicting a severe outcome. Ann Gastroenterol 2013;26(2):156–162.
  18. Werge M, Novovic S, Schmidt PN, et al. Infection increases mortality in necrotizing pancreatitis: a systematic review and meta-analysis. Pancreatology 2016;16(5):698–707. DOI: 10.1016/j.pan.2016.07.004.
  19. Boumitri C, Brown E, Kahaleh M. Necrotizing pancreatitis: current management and therapies. Clin Endosc 2017;50(4):357–365. DOI: 10.5946/ce.2016.152.
  20. Algül HAW, Huber W, Schmid RM. Acute pancreatitis. In: Podolsky DK, Fitz JG, Kalloo AN, et al. ed. Yamada's Textbook of Gastroenterology. Publishers John Wiley & Sons; 2015. p. 82.
  21. Blum T, Maisonneuve P, Lowenfels AB, et al. Fatal outcome in acute pancreatitis: its occurrence and early prediction. Pancreatology 2001;1(3):237–241. DOI: 10.1159/000055817.
  22. Carnovale A, Rabitti PG, Manes G, et al. Mortality in acute pancreatitis: is it an early or a late event? JOP 2005;6(5):438–444.
  23. Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg 2019;14:27. DOI: 10.1186/s13017-019-0247-0.
  24. Besselink MG, van Santvoort HC, Boermeester MA, et al. Timing and impact of infections in acute pancreatitis. Br J Surg 2009;96(3):267–273. DOI: 10.1002/bjs.6447.
  25. Jain S, Mahapatra SJ, Gupta S, et al. Infected pancreatic necrosis due to multidrug-resistant organisms and persistent organ failure predict mortality in acute pancreatitis. Clin Transl Gastroenterol 2018;9(10):190. DOI: 10.1038/s41424-018-0056-x.
  26. Thandassery RB, Yadav TD, Dutta U, et al. Hypotension in the first week of acute pancreatitis and APACHE II score predict development of infected pancreatic necrosis. Dig Dis Sci 2015;60(2):537–542. DOI: 10.1007/s10620-014-3081-y.
  27. Novati S, Sacchi P, Cima S, et al. General issues on microbial translocation in HIV-infected patients. Eur Rev Med Pharmacol Sci 2015;19(5):866–878.
  28. Evans ME, Pollack M. Effect of antibiotic class and concentration on the release of lipopolysaccharide from Escherichia coli. J Infect Dis 1993;167(6):1336–1343. DOI: 10.1093/infdis/167.6.1336.
  29. Matzinger P. The danger model: a renewed sense of self. Science 2002;296(5566):301–305. DOI: 10.1126/science.1071059.
  30. Bassi C, Falconi M, Girelli R, et al. Microbiological findings in severe acute pancreatitis. Surg Res Commun 1989;5(1):1–4.
  31. Shyu JY, Sainani NI, Sahni VA, et al. Necrotizing pancreatitis: diagnosis, imaging, and intervention. Radiographics 2014;34(5):1218–1239. DOI: 10.1148/rg.345130012.
  32. Noor MT, Radhakrishna Y, Kochhar R, et al. Bacteriology of infection in severe acute pancreatitis. JOP 2011;12(1):19–25.
  33. Khan A, Khan S. Antibiotics in acute necrotizing pancreatitis—perspective of a developing country. J Pak Med Assoc 2010;60(2):121–126.
  34. Babu RY, Gupta R, Kang M, et al. Predictors of surgery in patients with severe acute pancreatitis managed by the step up approach. Ann Surg 2013;257(4):737–750. DOI: 10.1097/SLA.0b013e318269d25d.
  35. Buchler MW, Uhl W, Malfertheiner P, et al. Acute pancreatitis, chronic pancreatitis, neoplasms of the pancreas. Diseases of the Pancreas. Basel: Karger Publishers; 2004.
  36. Schmid SW, Uhl W, Friess H, et al. The role of infection in acute pancreatitis. Gut 1999;45(2):311–316. DOI: 10.1136/gut.45.2.311.
  37. Liu H, Li W, Wang X, et al. Early gut mucosal dysfunction in patients with acute pancreatitis. Pancreas 2008;36(2):192–196. DOI: 10.1097/MPA.0b013e31815a399f.
  38. Vaishnavi C. Translocation of gut flora and its role in sepsis. Indian J Med Microbiol 2013;31(4):334–342. DOI: 10.4103/0255-0857.118870.
  39. Garg PK, Khanna S, Bohidar NP, et al. Incidence, spectrum and antibiotic sensitivity pattern of bacterial infections among patients with acute pancreatitis. J Gastroenterol Hepatol 2001;16(9):1055–1059. DOI: 10.1046/j.1440-1746.2001.02589.x.
  40. Traverso LW, Kozarek RA. Pancreatic necrosectomy: definitions and technique. J Gastrointest Surg 2005;9(3):436–439. DOI: 10.1016/j.gassur.2004.05.013.
  41. Raraty MG, Halloran CM, Dodd S, et al. Minimal access retroperitoneal pancreatic necrosectomy: improvement in morbidity and mortality with a less invasive approach. Ann Surg 2010;251(5):787–793. DOI: 10.1097/SLA.0b013e3181d96c53.
  42. Freeman ML, Werner J, van Santvoort HC, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas 2012;41(8):1176–1194. DOI: 10.1097/MPA.0b013e318269c660.
  43. Tan V, Charachon A, Lescot T, et al. Endoscopic transgastric versus surgical necrosectomy in infected pancreatic necrosis. Clin Res Hepatol Gastroenterol 2014;38(6):770–776. DOI: 10.1016/j.clinre.2014.06.016.
  44. Fu CY, Yeh CN, Hsu JT, et al. Timing of mortality in severe acute pancreatitis: experience from 643 patients. World J Gastroenterol 2007;13(13):1966–1969. DOI: 10.3748/wjg.v13.i13.1966.
  45. Pezzilli R, Uomo G, Gabbrielli A, et al. A prospective multicentre survey on the treatment of acute pancreatitis in Italy. Dig Liver Dis 2007;39(9):838–846. DOI: 10.1016/j.dld.2007.05.014.
  46. Bourgaux JF, Defez C, Muller L, et al. Infectious complications, prognostic factors and assessment of anti infectious management of 212 consecutive patients with acute pancreatitis. Gastroenterol Clin Biol 2007;31(4):431–435. DOI: 10.1016/S0399-8320(07)89406-1.
  47. Pando E, Alberti P, Hidalgo J, et al. The role of extra-pancreatic infections in the prediction of severity and local complications in acute pancreatitis. Pancreatology 2018; S1424-3903(18)30587-8. DOI: 10.1016/j.pan.2018.05.481.
  48. Grajales-Figueroa G, Hernández HAD, Portillo MAC, et al. Increased mortality from extrapancreatic infections in hospitalized patients with acute pancreatitis. Gastroenterol Res Pract 2019;2019:2789764. DOI: 10.1155/2019/2789764.
  49. Beger HG, Bittner R, Block S, et al. Bacterial contamination of pancreatic necrosis: a prospective clinical study. Gastroenterology 1986;91(2):433–438. DOI: 10.1016/0016-5085(86)90579-2.
  50. Bradley 3rd EL. A fifteen year experience with open drainage for infected pancreatic necrosis. Surg Gynecol Obstet 1993;177(3):215–222.
  51. Gerzof SG, Banks PA, Robbins AH, et al. Early diagnosis of pancreatic infection by computed tomography-guided aspiration. Gastroenterology 1987;93(6):1315–1320. DOI: 10.1016/0016-5085(87)90261-7.
  52. Rau B, Bothe A, Beger HG. Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage: changing patient characteristics and outcome in a 19-year, single-center series. Surgery 2005;138(1):28–39. DOI: 10.1016/j.surg.2005.03.010.
  53. Sahar N, Kozarek RA, Kanji ZS, et al. The microbiology of infected pancreatic necrosis in the era of minimally invasive therapy. Eur J Clin Microbiol Infect Dis 2018;37(7):1353–1359. DOI: 10.1007/s10096-018-3259-x.
  54. Isenmann R, Schwarz M, Rau B, et al. Characteristics of infection with candida species in patients with necrotizing pancreatitis. World J Surg 2002;26(3):372–376. DOI: 10.1007/s00268-001-0146-9.
  55. De Waele JJ, Vogelaers D, Hoste E, et al. Emergence of antibiotic resistance in infected pancreatic necrosis. Arch Surg 2004;139(12):1371–1375. DOI: 10.1001/archsurg.139.12.1371.
  56. Mowbray NG, Ben-Ismaeil B, Hammoda M, et al. The microbiology of infected pancreatic necrosis. Hepatobiliary Pancreat Dis Int 2018;17(5):456–460. DOI: 10.1016/j.hbpd.2018.08.007.
  57. Würstle S, Hapfelmeier A, Wöhrle C, et al. Changes in pathogen spectrum and antimicrobial resistance development in the time-course of acute necrotizing pancreatitis. J Gastroenterol Hepatol 2019;34(12):2096–2103. DOI: 10.1111/jgh.14748.
  58. De Waele JJ. Rational use of antimicrobials in patients with severe acute pancreatitis. Semin Respir Crit Care Med 2011;32(2):174–180. DOI: 10.1055/s-0031-1275529.
  59. Stigliano S, Sternby H, de Madaria E, et al. Early management of acute pancreatitis: a review of the best evidence. Dig Liver Dis 2017;49(6):585–594. DOI: 10.1016/j.dld.2017.01.168.
  60. Qiu Q, Nian YJ, Tang L, et al. Artificial neural networks accurately predict intra-abdominal infection in moderately severe and severe acute pancreatitis. J Dig Dis 2019;20(9):486–494. DOI: 10.1111/1751-2980.12796.
  61. Guarner-Argente C, Shah P, Buchner A, et al. Use of antimicrobials for EUS-guided FNA of pancreatic cysts: a retrospective, comparative analysis. Gastrointest Endosc 2011;74(1):81–86. DOI: 10.1016/j.gie.2011.03.1244.
  62. Nocker A, Cheung CY, Camper AK. Comparison of propidium monoazide with ethidium monoazide for differentiation of live vs dead bacteria by selective removal of DNA from dead cells. J Microbiol Methods 2006;67(2):310–320. DOI: 10.1016/j.mimet.2006.04.015.
  63. Nogva HK, Drømtorp SM, Nissen H, et al. Ethidium monoazide for DNA-based differentiation of viable and dead bacteria by 5′-nuclease PCR. Biotechniques 2003;34(4):804–813. DOI: 10.2144/03344rr02.
  64. Nocker A, Sossa KE, Camper AK. Molecular monitoring of disinfection efficacy using propidiummonoazide in combination with quantitative PCR. J Microbiol Methods 2007;70(2):252–260. DOI: 10.1016/j.mimet.2007.04.014.
  65. Pribylova R, Kubickova L, Babak V, et al. Effect of short- and long-term antibiotic exposure on the viability of Mycobacterium avium subsp. paratuberculosis as measured by propidium monoazide F57 real time quantitative PCR and culture. Vet J 2012;194(3):354–360. DOI: 10.1016/j.tvjl.2012.05.002.
  66. Banks PA, Gerzof SG, Langevin RE, et al. CT-guided aspiration of suspected pancreatic infection: bacteriology and clinical outcome. Int J Pancreatol 1995;18(3):265–270. DOI: 10.1007/BF02784951.
  67. Rau B, Pralle U, Mayer JM, et al. Role of ultrasonographically guided fine-needle aspiration cytology in the diagnosis of infected pancreatic necrosis. Br J Surg 1998;85(2):179–184. DOI: 10.1046/j.1365-2168.1998.00707.x.
  68. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence based guidelines for the management of acute pancreatitis. Pancreatology 2013;13(4 Suppl 2):e1–e15. DOI: 10.1016/j.pan.2013.07.063.
  69. Mofidi R, Suttie SA, Patil PV, et al. The value of procalcitonin at predicting the severity of acute pancreatitis and development of infected pancreatic necrosis: systematic review. Surgery 2009;146(1):72–81. DOI: 10.1016/j.surg.2009.02.013.
  70. Ji L, Wang G, Li L, et al. Risk factors for the need of surgical necrosectomy after percutaneous catheter drainage in the management of infection secondary to necrotizing pancreatitis pancreas. Pancreas 2018;47(4):436–443. DOI: 10.1097/MPA.0000000000001031.
  71. Ivanusa SY, Ivanov AM, Lazutkin MV, et al. Opportunities of modern laboratory diagnostics of infectious complications of acute pancreatitis (review). Klin Lab Diagn 2019;64(3):145–152. DOI: 10.18821/0869-2084-2019-64-3-145-152.
  72. Isenmann R, Runzi M, Kron M, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double blind trial. Gastroenterology 2004;126(4):997–1004. DOI: 10.1053/j.gastro.2003.12.050.
  73. Dellinger EP, Tellado JM, Soto NE, et al. Early antibiotic treatment for severe acute necrotizing pancreatitis: randomized, double-blind, placebo-controlled study. Ann Surg 2007;245(5):674–683. DOI: 10.1097/01.sla.0000250414.09255.84.
  74. Sakorafas GH, Lappas C, Mastoraki A, et al. Current trends in the management of infected necrotizing pancreatitis. Infect Disord Drug Targets 2010;10(1):9–14. DOI: 10.2174/187152610790410936.
  75. Villatoro E, Mulla M, Larvin M. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database Syst Rev 2010;5:CD002941. DOI: 10.1002/14651858.CD002941.pub3.
  76. Jiang K, Huang W, Yang XN, et al. Present and future of prophylactic antibiotics for severe acute pancreatitis. World J Gastroenterol 2012;18(3):279–284. DOI: 10.3748/wjg.v18.i3.279.
  77. Pederzoli P, Bassi C, Vesentini S, et al. A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet 1993;176(5):480–483.
  78. Sabharwal ER. Antibiotic susceptibility patterns of uropathogens in obstetric patients. N Am J Med Sci 2012;4(7):316–319. DOI: 10.4103/1947-2714.98591.
  79. Joshi S, Ray P, Manchanda V, et al. Methicillin resistant Staphylococcus aureus (MRSA) in India: prevalence & susceptibility pattern. Indian J Med Res 2013;137(2):363–369.
  80. Lim C, Takahashi E, Hongsuwan M, et al. Epidemiology and burden of multidrug-resistant bacterial infection in a developing country. eLife 2016;5:e18082. DOI: 10.7554/eLife.18082.
  81. Peirano G, van der Bij AK, Gregson DB, et al. Molecular epidemiology over an 11-year period (2000 to 2010) of extended-spectrum beta-lactamase-producing Escherichia coli causing bacteremia in a centralized Canadian region. J Clin Microbiol 2012;50(2):294–299. DOI: 10.1128/JCM.06025-11.
  82. Pitout JD. Enterobacteriaceae that produce extended-spectrum beta-lactamases and AmpC beta-lactamases in the community: the tip of the iceberg? Curr Pharm Des 2013;19(2):257–263. DOI: 10.2174/138161213804070348.
  83. Lee HS, Lee SK, Park DH, et al. Emergence of multidrug resistant infection in patients with severe acute pancreatitis. Pancreatology 2014;14(6):450–453. DOI: 10.1016/j.pan.2014.10.003.
  84. Nakaharai K, Morita K, Jo T, et al. Early prophylactic antibiotics for severe acute pancreatitis: a population-based cohort study using a nationwide database in Japan. J Infect Chemother 2018;24(9):753–758. DOI: 10.1016/j.jiac.2018.05.009.
  85. Kochhar R, Noor MT, Wig J. Fungal infections in severe acute pancreatitis. J Gastroenterol Hepatol 2011;26(6):952–959. DOI: 10.1111/j.1440-1746.2011.06685.x.
  86. Hoerauf A, Hammer S, Muller-Myhsok B, et al. Intra-abdominal candida infection during acute necrotizing pancreatitis has a high prevalence and is associated with increased mortality. Crit Care Med 1998;26(12):2010–2015. DOI: 10.1097/00003246-199812000-00031.
  87. Kujath P, Rosenfeldt M, Esnaashari H, et al. Fungal infections in patients with necrotizing pancreatitis: risk-factors, incidence, therapy. Mycoses 2005;48(Suppl 1):36–40. DOI: 10.1111/j.1439-0507.2005.01108.x.
  88. Schwender BJ, Gordon SR, Gardner TB. Risk factors for the development of intra-abdominal fungal infections in acute pancreatitis. Pancreas 2015;44(5):805–807. DOI: 10.1097/MPA.0000000000000334.
  89. Reuken PA, Albig H, Rödel J, et al. Fungal infections in patients with infected pancreatic necrosis and pseudocysts: risk factors and outcome. Pancreas 2018;47(1):92–98. DOI: 10.1097/MPA.0000000000000965.
  90. Grewe M, Tsiotos GG, Luque de-Leon E, et al. Fungal infection in acute necrotizing pancreatitis. J Am Coll Surg 1999;188(4):408–414. DOI: 10.1016/S1072-7515(98)00334-2.
  91. Gloor B, Müller CA, Worni M, et al. Pancreatic infection in severe pancreatitis: the role of fungus and multiresistant organisms. Arch Surg 2001;136(5):592–596. DOI: 10.1001/archsurg.136.5.592.
  92. De Waele JJ, Vogelaers D, Blot S, et al. Fungal infections in patients with severe acute pancreatitis and the use of prophylactic therapy clinical infectious diseases. Clin Infect Dis 2003;37(2):208–213. DOI: 10.1086/375603.
  93. Horibe M, Sanui M, Sasaki M, et al. Impact of antimicrobial prophylaxis for severe acute pancreatitis on the development of invasive candidiasis: a large retrospective multicenter cohort study pancreas. Pancreas 2019;48(4):537–543. DOI: 10.1097/MPA.0000000000001269.
  94. Safran DB, Dawson E. The effect of empiric and prophylactic treatment with fluconazole on yeast isolates in a surgical trauma intensive care unit. Arch Surg 1997;132(11):1184–1188. DOI: 10.1001/archsurg.1997.01430350034006.
  95. Eggimann P, Francioli P, Bille J, et al. Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients. Crit Care Med 1999;27(6):1066–1072. DOI: 10.1097/00003246-199906000-00019.
  96. Pelz RK, Hendrix CW, Swoboda SM, et al. Double-blind placebo-controlled trial of fluconazole to prevent candidal infections in critically ill surgical patients. Ann Surg 2001;233(4):542–548. DOI: 10.1097/00000658-200104000-00010.
  97. Büchler MW, Gloor B, Müller CA, et al. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 2000;232(5):619–626. DOI: 10.1097/00000658-200011000-00001.
  98. Otto W, Komorzycki K, Krawczyk M. Efficacy of antibiotic penetration into pancreatic necrosis. HPB (Oxford) 2006;8(1):43–48. DOI: 10.1080/13651820500467275.
  99. Schubert S, Dalhoff A. Activity of moxifloxacin, imipenem, and ertapenem against Escherichia coli, Enterobacter cloacae, Enterococcus faecalis, and Bacteroides fragilis in monocultures and mixed cultures in an in vitro pharmacokinetic/pharmacodynamic model simulating concentrations in the human pancreas. Antimicrob Agents Chemother 2012;56(12):6434–6436. DOI: 10.1128/AAC.00872-12.
  100. Buchler M, Malfertheiner P, Friess H, et al. Human pancreatic tissue concentration of bactericidal antibiotics. Gastroenterology 1992;103(6):1902–1908. DOI: 10.1016/0016-5085(92)91450-I.
  101. Garg PK, Sharma M, Madan K, et al. Primary conservative treatment results in mortality comparable to surgery in patients with infected pancreatic necrosis. Clin Gastroenterol Hepatol 2010;8(12):1089–1094. DOI: 10.1016/j.cgh.2010.04.011.
  102. Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010;362(16):1491–1502. DOI: 10.1056/NEJMoa0908821.
  103. Mouli VP, Sreenivas V, Garg PK. Efficacy of conservative treatment, without necrosectomy, for infected pancreatic necrosis: a systematic review and meta-analysis. Gastroenterology 2013;144(2):333–340. DOI: 10.1053/j.gastro.2012.10.004.
  104. Agarwal S, George J, Padhan RK, et al. Reduction in mortality in severe acute pancreatitis: a time trend analysis over 16 years. Pancreatology 2016;16(2):194–199. DOI: 10.1016/j.pan.2016.01.012.
  105. van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 2011;141(4):1254–1263. DOI: 10.1053/j.gastro.2011.06.073.
  106. Wolbrink DRJ, Kolwijck E, Ten Oever J, et al. Management of infected pancreatic necrosis in the intensive care unit: a narrative review. Clin Microbiol Infect 2020;26(1):18–25. DOI: 10.1016/j.cmi.2019.06.017.
  107. van Brunschot S, van Grinsven J, van Santvoort HC, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet 2018;391(10115):51–58. DOI: 10.1016/S0140-6736(17)32404-2.
  108. Driedger M, Zyromski NJ, Visser B, et al. Surgical transgastric necrosectomy for necrotizing pancreatitis—a single-stage procedure for walled-off pancreatic necrosis. Ann Surg 2020;271(1):163–168. DOI: 10.1097/SLA.0000000000003048.
  109. Diaz Jr JJ, Cullinane DC, Khwaja KA, et al. Eastern Association for the surgery of trauma: management of the open abdomen, part III-review of abdominal wall reconstruction. J Trauma Acute Care Surg 2013;75(3):376–386. DOI: 10.1097/TA.0b013e318294bee3.
  110. van Baal MC, van Santvoort HC, Bollen TL, et al. Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg 2010;98(1):18–27. DOI: 10.1002/bjs.7304.
  111. van Grinsven J, van Santvoort HC, Boermeester MA, et al. Timing of catheter drainage in infected necrotizing pancreatitis. Nat Rev Gastroenterol Hepatol 2016;13(5):306–312. DOI: 10.1038/nrgastro.2016.23.
  112. van Grinsven J, Timmerman P, van Lienden KP, et al. Proactive versus standard percutaneous catheter drainage for infected necrotizing pancreatitis. Pancreas 2017;46(4):518–523. DOI: 10.1097/MPA.0000000000000785.
  113. Shenvi S, Gupta R, Kang M, et al. Timing of surgical intervention in patients of infected necrotizing pancreatitis not responding to percutaneous catheter drainage. Pancreatology 2016;16(5):778–787. DOI: 10.1016/j.pan.2016.08.006.
  114. Horvath KD, Kao LS, Wherry KL, et al. A technique for laparoscopic-assisted percutaneous drainage of infected pancreatic necrosis and pancreatic abscess. Surg Endosc 2001;15(10):1221–1225. DOI: 10.1007/s004640080166.
  115. van Brunschot S, Fockens P, Bakker OJ, et al. Endoscopic transluminal necrosectomy in necrotising pancreatitis: a systematic review. Surg Endosc 2014;28(5):1425–1438. DOI: 10.1007/s00464-013-3382-9.
  116. Yi F, Ge L, Zhao J, et al. Meta-analysis: total parenteral nutrition versus total enteral nutrition in predicted severe acute pancreatitis. Intern Med 2012;51(6):523–530. DOI: 10.2169/internalmedicine.51.6685.
  117. Hsieh PH, Su HY, Lin CY, et al. Infection rate among nutritional therapies for acute pancreatitis: a systematic review with network meta-analysis of randomized controlled trials. PLoS One 2019;14(7):e0219151. DOI: 10.1371/journal.pone.0219151.
  118. van Minnen LP, Timmerman HM, Lutgendorff F, et al. Modification of intestinal flora with multispecies probiotics reduces bacterial translocation and improves clinical course in a rat model of acute pancreatitis. Surgery 2007;141(4):470–480. DOI: 10.1016/j.surg.2006.10.007.
  119. Olah A, Belagyi T, Issekutz A, et al. Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis. Br J Surg 2002;89(9):1103–1107. DOI: 10.1046/j.1365-2168.2002.02189.x.
  120. Olah A, Belagyi T, Poto L, et al. Synbiotic control of inflammation and infection in severe acute pancreatitis: a prospective, randomized, double blind study. Hepatogastroenterology 2007;54(74):590–594.
  121. Karakan T, Ergun M, Dogan I, et al. Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fiber supplementation versus standard enteral solution: a prospective randomized double-blind study. World J Gastroenterol 2007;13(19):2733–2737. DOI: 10.3748/wjg.v13.i19.2733.
  122. Besselink MG, Van Santvoort HC, Buskens E, et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet 2008;371(9613):651–659. DOI: 10.1016/S0140-6736(08)60207-X.
  123. Qin HL, Zheng JJ, Tong DN, et al. Effect of Lactobacillus plantarum enteral feeding on the gut permeability and septic complications in the patients with acute pancreatitis. Eur J Clin Nutr 2008;62(7):923–930. DOI: 10.1038/sj.ejcn.1602792.
  124. Cui LH, Wang XH, Peng LH, et al. The effects of early enteral nutrition with addition of probiotics on the prognosis of patients suffering from severe acute pancreatitis. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2013;25(4):224–228. DOI: 10.3760/cma.j.issn.2095-4352.2013.04.011.
  125. Gou S, Yang Z, Liu T, et al. Use of probiotics in the treatment of severe acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Crit Care 2014;18(2):R57. DOI: 10.1186/cc13809.
  126. Wu P, Yu Y, Li L, et al. Effect and safety of probiotics combined early enteral nutrition on severe acute pancreatitis patients. Biomed Res 2017;28(3):1403–1407.
  127. Bouwense SA, van Baal MC, van Santvoort HC, et al. Prophylaxis and treatment with antibiotics or probiotics in acute pancreatitis. Pancreapedia: Exocrine Pancreas Knowledge Base 2016. DOI: 10.3998/panc.2016.19.
  128. Pan LL, Li J, Shamoon M, et al. Recent advances on nutrition in treatment of acute pancreatitis. Front Immunol 2017;8:762. DOI: 10.3389/fimmu.2017.00762.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.