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Emergence of Antibiotic Resistance in Infected Pancreatic Necrosis
Jan J. De Waele, MD;
Dirk Vogelaers, PhD;
Eric Hoste, MD;
Stijn Blot, PhD;
Francis Colardyn, MD
Arch Surg. 2004;139:1371-1375.
Background Overall, the use of antibiotics in the treatment of patients with severe acute pancreatitis has increased owing to the use of antibiotic prophylaxis.
Hypothesis The incidence of antibiotic-resistant (AB-R) bacteria in infected pancreatitis is related to prolonged antibiotic treatment and may affect outcome.
Design Case series.
Setting Fifty-six–bed intensive care unit of a tertiary care center.
Patients Forty-six consecutive patients with infected pancreatic necrosis.
Main Outcome Measures Occurrence rate of AB-R organisms in pancreatic infection, overall duration of antibiotic treatment prior to infection, and mortality, defined as inhospital mortality.
Results Infection with AB-R microorganisms was found in 24 (52%) of 46 patients. Primary infection was present in 7 patients; in 21 patients, nosocomial surinfection with AB-R organisms occurred. Patients with AB-R infections were treated with antibiotics for a longer period (24 vs 15 days, P<.05), while disease severity and the incidence of organ failure were not statistically significantly different. The intensive care unit stay was significantly longer in patients with AB-R infections (23 vs 31 days, P = .02). Mortality was not statistically significantly different in patients with AB-R infections (37% vs 28%, P = .23).
Conclusions The occurrence rate of infections with AB-R organisms in our patients with severe acute pancreatitis was high and was associated with a longer intensive care unit stay, but no increased mortality could be demonstrated. The duration of antibiotic treatment was increased in patients in whom AB-R infections developed.
Author Affiliations: Intensive Care Unit (Drs De Waele, Hoste, Blot, and Colardyn) and Centre for Infectious Diseases (Dr Vogelaers), Ghent University Hospital, Ghent, Belgium.
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