ABSTRACT
Infectious complications in severe acute pancreatitis are associated with considerable
morbidity and mortality. The course of the disease is often protracted, and patients
often stay in the hospital for several weeks. Diagnosis of infected pancreatic necrosis
is difficult, and the treatment consists of source control and antibiotic treatment.
Antibiotic use should be rational in terms of a rational indication, a rational spectrum,
and a rational duration. Prophylactic antibiotics are not effective in reducing the
incidence of (peri)-pancreatic infection in patients with severe disease (or even
documented necrotizing pancreatitis). The only rational indication for antibiotics
is documented infection. The spectrum of empirical antibiotics should include both
aerobic and anaerobic gram-negative and gram-positive microorganisms. Also, fungal
infections are often present in these patients, and antifungal coverage or even prophylaxis
should be considered, especially if multiple risk factors for invasive candidiasis
are present. Although initiation of antibiotics may be a difficult decision, stopping
antibiotic therapy often proves to be even more difficult. Currently, no tools are
available to guide antimicrobial treatment. Antibiotic use is only effective if proper
source control has been established.
KEYWORDS
Acute pancreatitis - infected pancreatic necrosis - necrotizing pancreatitis - severe
acute pancreatitis - walled-off necrosis
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Jan J De WaeleM.D. Ph.D.
Intensive Care Unit 1K12-C, Ghent University Hospital
De Pintelaan 185, 9000 Ghent, Belgium
eMail: jan.dewaele@UGent.be
