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Analysis of Antibiotic Therapy in Acute Severe Pancreatitis

S. Karthikeyan, Professor, Dept. of General Surgery, PSG Institute of Medical Sciences & Research & PSG Hospitals (Affliated To The Tamilnadu Dr MGR Medical University) Coimbatore, Tamil Nadu 641004, India. , S. Karthikeyan1 , Subbaiah S.2 , Vimal Raj3 , Prethee Martina4

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New Indian Journal of Surgery 9(3):p 323-327, May-June 2018. | DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.9318.14

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Abstract

Background: Acute Pancreatitis is a common surgical entity that is increasing in incidence. Gallstones and alcohol consumption remain the major contributors of
Acute pancreatitis. The disease usually follows a prolonged course with increased hospital stay, early and late complications contributing to increased patient morbidity and mortality. Traditionally the role of antibiotics is usually limited to severe necrotising pancreatitis. There is however increasing evidence to prove the role of antibiotic therapy in reducing mortality and long term morbidity in acute pancreatitis patients.

Objectives:
1. To retrospectively analyse antibiotic therapy in patients with Acute severe pancreatitis in the years
2014 - 2017 in the tertiary care hospital PSG IMSR located in Coimbatore, Tamilnadu, India
2. To analyse the role of antibiotics in patient prognosis and outcome

Type of study: Retrospective Observational study.

Duration of study: January 2014-January 2017.

Methodology: The present study was conducted in PSG Institute of Medical Sciences & Research, Coimbatore. We did a thorough retrospective analysis of case files of 900 patients with acute severe pancreatitis. Analysing the available data from case files.

Results: Of 900 patients, 411satisfied the inclusion criteris, of these 63% (n=258) of patients were started antibiotics within 48 hrs of hospital admission. The first choice antibiotics were Piperacillin tazobactum and metronidazole in 45% of cases, Fluoroquinolones and metronidazole in 12% of cases and Cefaperazone sulbactum ± metronidazole in 14% of cases. In 26% of cases a combination of imipenem + Cilastatin was used. Antibiotic use did not improve survival, nor was there any observed survival benefit when the different antibiotic agents were compared (p = 0.7 and 0.4 respectively). The timing of antibiotic use also does not appear to confer a survival benefit (p = 0.5). All patients with proven pancreatic infection died, there was not a significant difference in survival in those with extra-pancreatic infections (p = 0.2).

Keywords: Acute Pancreatitis; Necrotising Pancreatitis; Severe Acute Pancreatitis; Antibiotic Prophylaxis; Retrospective Analysis.

 

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DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.9318.14

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