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- W4312378856 abstract "Introduction: Although antibiotic treatment is one of the cornerstones of management of (suspected) infected necrotizing pancreatitis, indication, timing, duration and the type of antimicrobial regimes is still debated and vary. Methods: We performed a post-hoc analysis of a prospective multicenter cohort of 449 patients with necrotizing pancreatitis treated in 15 Dutch hospitals (2010 to 2019). Results on microbiological cultures and antimicrobial therapy were analysed. Results: Antimicrobial therapy was started in 369 (82%) of all patients with necrotizing pancreatitis, after a median of 5 (P25-P75: 1 – 14) days after admission. In 224/369 (70%) patients, the first antimicrobial therapy was started without a confirmed infection. Although carbapenems, specifically meropenem (n=75, 29%), were most frequently used as empirical antimicrobial therapy, Enterococcus faecium (which is intrinsically resistant to carbapenems) was frequently (24%) cultured in infected pancreatic necrosis. Multidrug-resistant bacteria were rare in the initial culture sample (2%), but increased to 14% in subsequent cultures. Empirical antimicrobial therapy started before the positive culture was appropriate in 64/128 patients (50%) with a positive pancreatic culture. In 87% of the patients with a culture that contained (partial) resistant bacteria the antibiotic regime was adjusted appropriately. Conclusion: In daily clinical practice, antimicrobial therapy are started early during necrotizing pancreatitis, mostly without a confirmed infection. E. faecium was the most frequently cultured microbe. Based on bacterial resistance and yeast involvement, empirically administered antibiotics often turn out inappropriate. Optimization of antimicrobial therapy has the potential to reduce unnecessary antibiotic use while improving clinical outcomes of patients with (infected) necrotizing pancreatitis." @default.
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- W4312378856 date "2022-01-01" @default.
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- W4312378856 title "Microbiology and Antimicrobial Therapy in (Infected) Necrotizing Pancreatitis: A Prospective Observational Cohort Study" @default.
- W4312378856 doi "https://doi.org/10.1016/j.hpb.2022.05.508" @default.
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