EBM

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EBM

• R1 ???

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• P patient with acute pancreatitis,
• pancreatic necrosis
• I antibiotics used
• C without antibiotics
• O Outcome

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• Acute pancreatitis is a common abdominal
  emergency with nospecific treatment.
• Pancreatic necrosis may complicate severe
  attacks, detectable by CT. Necrosis can become
  infected, making surgical intervention necessary
  and increasing mortality to more than 40.

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• Pancreatic necrosis is common in patients who
  develop MOSF (multiple organ-system failure)
• Although antibiotics known to penetrate viable
  pancreatic tissue may not penetrate areas of
  necrosis effectively
• Experimental studies suggest that antibiotic
  therapy may prevent infection, but could promote
  resistance and fungal infection.

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• Administration of potent antibacterial therapy
  for 2 weeks or more could potentially increase
  the risks of antibacterial resistance and
  opportunistic fungal infection
• A study of two different prophylactic
  antibacterial regimens found the most isolated
  microorganisms in pancreatic necrosis specimens
  were methicillin resistant staphylococcus aureus
  (MRSA) (8.3) and candida glabrata (6.6)

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Criteria for considering studies for this review

• Types of studies - RCTs
• Types of participants - severe acute
  pancreatitis ,diagnosed by contrast enhanced CT
• Types of intervention - Antibacterial therapy
  administered within seven days of onset of the
  attack.

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• Types of outcome measures
• Primary mortality and rates of microbiologically
  proven infected pancreatic necrosis
• (needle aspirate or operative samples)
• Secondary rates of microbiologically proven
  non-pancreatic infection (respiratory, urinary,
  central venous line sepsis) ,operative rates,
  antimicrobial drug resistant infections and
  opportunistic fungal infections.

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Searchstrategy

• The Cochrane Library (Issue1,2006),
• MEDLINE(January1966-December2005)
• EMBASE(January1980-December2005)
• CINAHL(January1982-December2005)

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• Main results
• -Five studies , 294 patients.
• -significantly less mortality with therapy (6)
  versus controls (15.3),
• -Infected pancreatic necrosis rates ,operative
  rates or non-pancreatic infection rates were not
  significantly different

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• -Fungal infections , antibiotic resistance were
  not significantly different
• -With beta lactam prophylaxis there was
  significantly less mortality (6.3) versus
  controls (16.7)
• -No significant differences were seen with
  quinolone plus imidazole.

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Authors' conclusions

• Antibiotic prophylaxis appeared to be associated
  with significantly decreased mortality but not
  infected pancreatic necrosis.
• Beta lactams were associated with significantly
  decreased mortality and infected pancreatic
  necrosis, but quinolone plus imidazole regimens
  were not.

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