Evaluation of local instillation of antibiotics in infected walled-off pancreatic necrosis

TY - JOUR

T1 - Evaluation of local instillation of antibiotics in infected walled-off pancreatic necrosis

AU - Werge, Mikkel

AU - Novovic, Srdan

AU - Roug, Stine

AU - Knudsen, Jenny Dahl

AU - Feldager, Erik

AU - Gluud, Lise Lotte

AU - Schmidt, Palle Nordblad

N1 - Copyright © 2018 IAP and EPC. Published by Elsevier B.V. All rights reserved.

PY - 2018/9

Y1 - 2018/9

N2 - BACKGROUND: Infected walled-off pancreatic necrosis (WON) is associated with increased morbidity and mortality. Systemic antibiotics are the main treatment, but are associated with adverse reactions and risk of superinfections. This study evaluates the efficacy of local instillation of antibiotics into WON.METHODS: We performed a retrospective cohort study of all consecutive patients with infected WON, who were treated with endoscopic transmural drainage and necrosectomy (ETDN) at a tertiary referral hospital between 2012 and 2016. A total of 91 patients were included. Patients often received concomitant intravenous and local antibiotics. Local antibiotics were added to the irrigation fluid depending on microbiological findings. A beneficial response was defined as the eradication of a microbe on subsequent culturing. Univariable and multivariable logistic regression analyses were used to evaluate antimicrobial efficacy.RESULTS: At the first drainage 81 (86%) patients had infected and 10 sterile WON. Among patients with bacterial infections, neither local nor systemic antibiotics were associated with the eradication of microbes between first and second culture. Between the second and third culture, the use of local antibiotics was associated with the eradication of microbes (OR, 2.54; 95% CI, 1.25-5.18; p = 0.01), but not systemic antibiotics (OR, 0.75; 95% CI, 0.38-1.38; p = 0.33). Twelve patients had fungal infections treated with local amphotericin B between first and second culture. The fungus was eradicated in all 12 patients.CONCLUSION: Local instillation of antibiotics may be a promising supplement to systemic administration.

AB - BACKGROUND: Infected walled-off pancreatic necrosis (WON) is associated with increased morbidity and mortality. Systemic antibiotics are the main treatment, but are associated with adverse reactions and risk of superinfections. This study evaluates the efficacy of local instillation of antibiotics into WON.METHODS: We performed a retrospective cohort study of all consecutive patients with infected WON, who were treated with endoscopic transmural drainage and necrosectomy (ETDN) at a tertiary referral hospital between 2012 and 2016. A total of 91 patients were included. Patients often received concomitant intravenous and local antibiotics. Local antibiotics were added to the irrigation fluid depending on microbiological findings. A beneficial response was defined as the eradication of a microbe on subsequent culturing. Univariable and multivariable logistic regression analyses were used to evaluate antimicrobial efficacy.RESULTS: At the first drainage 81 (86%) patients had infected and 10 sterile WON. Among patients with bacterial infections, neither local nor systemic antibiotics were associated with the eradication of microbes between first and second culture. Between the second and third culture, the use of local antibiotics was associated with the eradication of microbes (OR, 2.54; 95% CI, 1.25-5.18; p = 0.01), but not systemic antibiotics (OR, 0.75; 95% CI, 0.38-1.38; p = 0.33). Twelve patients had fungal infections treated with local amphotericin B between first and second culture. The fungus was eradicated in all 12 patients.CONCLUSION: Local instillation of antibiotics may be a promising supplement to systemic administration.

KW - Administration, Intravenous

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Amphotericin B/therapeutic use

KW - Anti-Bacterial Agents/administration & dosage

KW - Antifungal Agents/therapeutic use

KW - Bacterial Infections/drug therapy

KW - Cohort Studies

KW - Drainage

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Mycoses/drug therapy

KW - Pancreatitis, Acute Necrotizing/drug therapy

KW - Retrospective Studies

U2 - 10.1016/j.pan.2018.06.005

DO - 10.1016/j.pan.2018.06.005

M3 - Journal article

C2 - 29958817

SN - 1424-3903

VL - 18

SP - 642

EP - 646

JO - Pancreatology

JF - Pancreatology

IS - 6

ER -