Skip to main content
PMC home page
Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1992 Sep;74(5):329–334.

Prevention of bacterial infection and sepsis in acute severe pancreatitis.

P McClelland 1, A Murray 1, M Yaqoob 1, H K Van Saene 1, J M Bone 1, S M Mostafa 1
PMCID: PMC2497634  PMID: 1329602

Abstract

Between 1984 and 1986 six patients with acute respiratory failure (requiring ventilation for at least 3 days) complicating acute pancreatitis were managed on the intensive care unit (median ventilation period 6 days; range 3-41 days). Between 1987 and 1989 nine similar patients were managed (median ventilation period 35 days, range 4-69 days), and a regimen of enteral tobramycin, polymyxin and amphotericin to selectively decontaminate the digestive tract (SDD) was introduced. Five of six patients treated before 1987 had serious infections (three Gram-negative, one fungal), compared with only one of nine patients treated with SDD (P < 0.05). Clinical signs of sepsis were evident for 62% of the pre-SDD period, compared with 39% of the period during SDD therapy (P < 0.001). Systemic antibiotic prescribing was reduced in the SDD group; however, mortality remained unaffected with only two patients surviving pre-SDD and three during SDD treatment. SDD reduces infection rates and sepsis in patients with acute pancreatitis and may help to improve the prognosis of this life-threatening condition.

Full text

PDF
334

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alverdy J. C. Effects of glutamine-supplemented diets on immunology of the gut. JPEN J Parenter Enteral Nutr. 1990 Jul-Aug;14(4 Suppl):109S–113S. doi: 10.1177/014860719001400415. [DOI] [PubMed] [Google Scholar]
  2. Aranha G. V., Prinz R. A., Greenlee H. B. Pancreatic abscess: an unresolved surgical problem. Am J Surg. 1982 Nov;144(5):534–538. doi: 10.1016/0002-9610(82)90575-x. [DOI] [PubMed] [Google Scholar]
  3. Beger H. G., Krautzberger W., Bittner R., Block S., Büchler Results of surgical treatment of necrotizing pancreatitis. World J Surg. 1985 Dec;9(6):972–979. doi: 10.1007/BF01655406. [DOI] [PubMed] [Google Scholar]
  4. Berne T. V., Donovan A. J. Synchronous anterior celiotomy and posterior drainage of pancreatic abscess. Arch Surg. 1981 May;116(5):527–533. doi: 10.1001/archsurg.1981.01380170023004. [DOI] [PubMed] [Google Scholar]
  5. Bradley E. L., 3rd Antibiotics in acute pancreatitis. Current status and future directions. Am J Surg. 1989 Nov;158(5):472–478. doi: 10.1016/0002-9610(89)90290-0. [DOI] [PubMed] [Google Scholar]
  6. Bradley E. L., 3rd, Fulenwider J. T. Open treatment of pancreatic abscess. Surg Gynecol Obstet. 1984 Dec;159(6):509–513. [PubMed] [Google Scholar]
  7. Driks M. R., Craven D. E., Celli B. R., Manning M., Burke R. A., Garvin G. M., Kunches L. M., Farber H. W., Wedel S. A., McCabe W. R. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization. N Engl J Med. 1987 Nov 26;317(22):1376–1382. doi: 10.1056/NEJM198711263172204. [DOI] [PubMed] [Google Scholar]
  8. Finch W. T., Sawyers J. L., Schenker S. A prospective study to determine the efficacy of antibiotics in acute pancreatitis. Ann Surg. 1976 Jun;183(6):667–671. doi: 10.1097/00000658-197606000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Foulis A. K., Murray W. R., Galloway D., McCartney A. C., Lang E., Veitch J., Whaley K. Endotoxaemia and complement activation in acute pancreatitis in man. Gut. 1982 Aug;23(8):656–661. doi: 10.1136/gut.23.8.656. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Howes R., Zuidema G. D., Cameron J. L. Evaluation of prophylactic antibiotics in acute pancreatitis. J Surg Res. 1975 Feb;18(2):197–200. doi: 10.1016/0022-4804(75)90016-5. [DOI] [PubMed] [Google Scholar]
  11. Johanson W. G., Pierce A. K., Sanford J. P. Changing pharyngeal bacterial flora of hospitalized patients. Emergence of gram-negative bacilli. N Engl J Med. 1969 Nov 20;281(21):1137–1140. doi: 10.1056/NEJM196911202812101. [DOI] [PubMed] [Google Scholar]
  12. Keene A. R., Cullen D. J. Therapeutic Intervention Scoring System: update 1983. Crit Care Med. 1983 Jan;11(1):1–3. doi: 10.1097/00003246-198301000-00001. [DOI] [PubMed] [Google Scholar]
  13. LeFrock J. L., Ellis C. A., Weinstein L. The impact of hospitalization on the aerobic fecal microflora. Am J Med Sci. 1979 May-Jun;277(3):269–274. doi: 10.1097/00000441-197905000-00004. [DOI] [PubMed] [Google Scholar]
  14. Leonard E. M., van Saene H. K., Shears P., Walker J., Tam P. K. Pathogenesis of colonization and infection in a neonatal surgical unit. Crit Care Med. 1990 Mar;18(3):264–269. doi: 10.1097/00003246-199003000-00003. [DOI] [PubMed] [Google Scholar]
  15. Lumsden A., Bradley E. L., 3rd Secondary pancreatic infections. Surg Gynecol Obstet. 1990 May;170(5):459–467. [PubMed] [Google Scholar]
  16. Marshall J., Sweeney D. Microbial infection and the septic response in critical surgical illness. Sepsis, not infection, determines outcome. Arch Surg. 1990 Jan;125(1):17–23. doi: 10.1001/archsurg.1990.01410130019002. [DOI] [PubMed] [Google Scholar]
  17. McClelland P., Coakley J., Williams P. S., Bone J. M., Mostafa S. M., Williams P. G. Staphylococcal peritonitis following selective decontamination of digestive tract. Lancet. 1988 Oct 1;2(8614):800–800. doi: 10.1016/s0140-6736(88)92455-5. [DOI] [PubMed] [Google Scholar]
  18. Morrison D. C., Jacobs D. M. Binding of polymyxin B to the lipid A portion of bacterial lipopolysaccharides. Immunochemistry. 1976 Oct;13(10):813–818. doi: 10.1016/0019-2791(76)90181-6. [DOI] [PubMed] [Google Scholar]
  19. Newhouse M., Sanchis J., Bienenstock J. Lung defense mechanisms (first of two parts). N Engl J Med. 1976 Oct 28;295(18):990–998. doi: 10.1056/NEJM197610282951805. [DOI] [PubMed] [Google Scholar]
  20. Northey D., Adess M. L., Hartsuck J. M., Rhoades E. R. Microbial surveillance in a surgical intensive care unit. Surg Gynecol Obstet. 1974 Sep;139(3):321–325. [PubMed] [Google Scholar]
  21. Pemberton J. H., Nagorney D. M., Becker J. M., Ilstrup D., Dozois R. R., Remine W. H. Controlled open lesser sac drainage for pancreatic abscess. Ann Surg. 1986 Jun;203(6):600–604. doi: 10.1097/00000658-198606000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Ranson J. H., Spencer F. C. Prevention, diagnosis, and treatment of pancreatic abscess. Surgery. 1977 Jul;82(1):99–106. [PubMed] [Google Scholar]
  23. Ranson J. H., Turner J. W., Roses D. F., Rifkind K. M., Spencer F. C. Respiratory complications in acute pancreatitis. Ann Surg. 1974 May;179(5):557–566. doi: 10.1097/00000658-197405000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Schumacker P. T., Cain S. M. The concept of a critical oxygen delivery. Intensive Care Med. 1987;13(4):223–229. doi: 10.1007/BF00265110. [DOI] [PubMed] [Google Scholar]
  25. Stoutenbeek C. P., van Saene H. K., Miranda D. R., Zandstra D. F. The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med. 1984;10(4):185–192. doi: 10.1007/BF00259435. [DOI] [PubMed] [Google Scholar]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

RESOURCES