ЕMPIRICAL ANTIBACTERIAL THERAPY OF INFECTED NECROTIC PANCREATITIS IN ENVIRONMENT OF ANTIBIOTICORESISTANCE OF CAUSATIVE AGENTS

Keywords: pancreatic infection, еmpirical antibacterial therapy, аntibiotical resistance of causative agent

Abstract

Objective. To elaborate  the scheme of empirical antibacterial therapy (АBТ) in patients in infected acute necrotic pancreatitis (ANP), basing on retrospective analysis of results of bacteriological investigation and studying of antibiotic sensitivity of causative agents.

Маterials and methods. Analysis of microbial landscape of the puncture and excretions materials from drains with determination of antibiotic sensitivity and antibiotic resistance towards antimicrobial preparations (АМP) in 52 patients, suffering infected ANP, who were treated in the clinic for the 2015 – 2016 yrs period, was conducted.

Results. Міcrobial landscape of an acute parapancreatic and necrotic accumulations of liquid in accordance to data of primary investigation in 82.7% observations was presented by monoinfection, in 17.3% – by associations of gram–negative microflora. Klebsiella pneumoniae dominated (in 26.7% of observations), E. coli (in 21.7%), Pseudomonas aeruginosa (in 17.4%), Acinetobacter baumannii (in 12%). Panresistant microflora were revealed in 33% observations and presented by Acinetobacter baumannii.

Conclusion. Basing on retrospective analysis of identification of the pancreatic infection causative agents and determination of their antibiotic sensitivity the scheme of empirical ABT was proposed. Fluoroquinolones of  second generation in combination with antianaerobic preparations, carbapenems are considered the «reserved» antibiotics, ureidopenicillines with antianaerobic preparations are recommended as a first–line therapy.

Author Biographies

O. I. Dronov, Bogomolets National Medical University, Kyiv

PhD, professor, Department of General Surgery №1. Cheaf of Zemskov Kyiv City Center of Hepatobiliary and Pancreas Surgery, Kyiv, Ukraine. Address: 01004, Shevchenko avenue, 13, Kiev, Ukraine, tel. +38044 234 4062.

І. О. Kovalska, Bogomolets National Medical University, Kyiv

 PhD, professor, Department of General Surgery №1. Address: 01004, Shevchenko avenue, 13, Kiev, Ukraine, tel. +38044 234 4062.

A. I. Gorlach, Bogomolets National Medical University, Kyiv

PhD, associate professor, Department of General Surgery №1. Address: 01004, Shevchenko avenue, 13, Kiev, Ukraine, tel. +38044 234 4062.

K. O. Zadorozhna, Bogomolets National Medical University, Kyiv

Student, Department of General Surgery №1. Address: 01004, Shevchenko avenue, 13, Kiev, Ukraine, tel. +38044 234 4062.

V. V. Tynkalyuk, Kyiv Centre of Surgery for Diseases of Liver, Biliary Ducts and Pancreas named after V. S. Zemskov

Anesthesiologist, Intensive Care Unit. Address: Holosiivskyi avenue, 59B, +380445255329.

S. S. Shapoval, Kyiv Centre of Surgery for Diseases of Liver, Biliary Ducts and Pancreas named after V. S. Zemskov

Anesthesiologist, Intensive Care Unit. Address: Holosiivskyi avenue, 59B, +380445255329.

I. V. Sotnik, Kyiv Centre of Surgery for Diseases of Liver, Biliary Ducts and Pancreas named after V. S. Zemskov

Anesthesiologist, Intensive Care Unit. Address: Holosiivskyi avenue, 59B, +380445255329.

References

1. Werge M, Novovic S, Palle N, Gluud L. Infection increases mortality in necrotizing pancreatitis: A systematic review and meta–analysis. Pancreatology. 2016;16:698–707.

2. Villatoro E, Mulla M, Larvin M. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database of Systematic Reviews, 2010;5:53.

3. Antiboitic Guidelines 2015 – 2016. Treatment recommendations for adult inpatients Johns Hopkins medicine,163.

4. Wittau M, Mayer B, Scheele J, et al. Systematic review and meta–analysis of antibiotic prophylaxis in severe acute pancreatitis. Scand J Gastroenterol. 2011;46(3):261–70.

5. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence–based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13:1–15.

6. Dronov AY, Kovalskaia YA, Lubenets TV, Kovalenko AP. Antybyotykoterapyia pry ostrom nekrotycheskom pankreatyte. Ukrainskyi zhurnal khirurhii. 2009;(1):164–5. [In Ukrainian].

7. Global priority list of antibiotic–resistant bacteria to guide research, discovery and development of new antibiotics. Geneva: World Health Organization; 2017:1–4.

8. De Campos T, Assef JC, Rasslan S. Questions about the use antibiotics in acute pancreatitis. World Journal of Emergency Surgery. 2006;20(1):1–6.

9. International Guidelines for Management of Severe Sepsis and Septic Shock 2013. Society of Critical Care Medicine, European Society of Intensive Care Medicine. 1 –8.
Published
2017-07-29
Section
General Problems of Surgery