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Rational use of antimicrobials in patients with severe acute pancreatitis

Jan De Waele (UGent)
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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
EARLY ANTIBIOTIC-TREATMENT, CLINICAL-TRIAL, ACUTE NECROTIZING PANCREATITIS, severe acute pancreatitis, PROPHYLAXIS, Acute pancreatitis, necrotizing pancreatitis, walled-off necrosis, infected pancreatic necrosis, MANAGEMENT, MORTALITY, NECROSIS, ORGAN FAILURE, INFECTION, DOUBLE-BLIND

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Citation

Please use this url to cite or link to this publication:

MLA
De Waele, Jan. “Rational Use of Antimicrobials in Patients with Severe Acute Pancreatitis.” SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE 32.2 (2011): 174–180. Print.
APA
De Waele, Jan. (2011). Rational use of antimicrobials in patients with severe acute pancreatitis. SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE, 32(2), 174–180.
Chicago author-date
De Waele, Jan. 2011. “Rational Use of Antimicrobials in Patients with Severe Acute Pancreatitis.” Seminars in Respiratory and Critical Care Medicine 32 (2): 174–180.
Chicago author-date (all authors)
De Waele, Jan. 2011. “Rational Use of Antimicrobials in Patients with Severe Acute Pancreatitis.” Seminars in Respiratory and Critical Care Medicine 32 (2): 174–180.
Vancouver
1.
De Waele J. Rational use of antimicrobials in patients with severe acute pancreatitis. SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE. 2011;32(2):174–80.
IEEE
[1]
J. De Waele, “Rational use of antimicrobials in patients with severe acute pancreatitis,” SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE, vol. 32, no. 2, pp. 174–180, 2011.
@article{1986655,
  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.},
  author       = {De Waele, Jan},
  issn         = {1069-3424},
  journal      = {SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE},
  keywords     = {EARLY ANTIBIOTIC-TREATMENT,CLINICAL-TRIAL,ACUTE NECROTIZING PANCREATITIS,severe acute pancreatitis,PROPHYLAXIS,Acute pancreatitis,necrotizing pancreatitis,walled-off necrosis,infected pancreatic necrosis,MANAGEMENT,MORTALITY,NECROSIS,ORGAN FAILURE,INFECTION,DOUBLE-BLIND},
  language     = {eng},
  number       = {2},
  pages        = {174--180},
  title        = {Rational use of antimicrobials in patients with severe acute pancreatitis},
  url          = {http://dx.doi.org/10.1055/s-0031-1275529},
  volume       = {32},
  year         = {2011},
}

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