Evaluation of local instillation of antibiotics in infected walled-off pancreatic necrosis
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Evaluation of local instillation of antibiotics in infected walled-off pancreatic necrosis. / Werge, Mikkel; Novovic, Srdan; Roug, Stine; Knudsen, Jenny Dahl; Feldager, Erik; Gluud, Lise Lotte; Schmidt, Palle Nordblad.
I: Pancreatology, Bind 18, Nr. 6, 2018, s. 642-646.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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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
Y1 - 2018
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
VL - 18
SP - 642
EP - 646
JO - Pancreatology
JF - Pancreatology
SN - 1424-3903
IS - 6
ER -
ID: 216564466