Microbial spectrum and rational antibacterial therapy in treatment of infected forms of necrotic pancreatitis
DOI:
https://doi.org/10.34287/MMT.2(41).2019.2Abstract
The most significant areas of scientific and practical research in urgent pancreatology of the last decade are the study of the course of necrotic pancreatitis with the evaluation of the effectiveness of antibiotic therapy at different stages of the disease according to microbiological studies, nosocomial infection and the development of sepsis.
Purposw of the study. To study the effectiveness of antibacterial therapy in complex treatment of infected forms of necrotizing pancreatitis, depending on the species composition of the infection, the severity of the pathology and the development of sepsis.
Materials and methods. The study included 48 patients with infected forms of necrotic pancreatitis over the past two years undergoing treatment at the Department of Anesthesiology and Intensive Care of Zaporizhzhia 3rd City Clinical Hospital in 2017–2018.
Results. Research of the species composition of microorganisms showed that there is predominant gram-negative flora in pancreatogenic infection such as: Pseudomonas aeruginosa – 26,3%, Acinetobacter spp. – 21,1%, the Enterobacteriaceae family: Klebsiella pneumoniae – 10,5% and Escherichia coli – 15,8%. The detected spectrum of microorganisms gives an idea of the main pathogens characteristic of infected forms of necrotizing pancreatitis. Antibiotic sensibility analysis showed that high activity against pathogens was observed in meropenem, taygecycline and tobramycin. In 21% of patients, resistant strains of Ps. Aeruginosa were detected, but in 3 patients there was a positive dynamics in the use of detoxication therapy with inclusion of extracorporal methods (discrete plasmapheresis) in combination with two-component antibiotic therapy (meropenem + linezolid).
Conclusion. The analysis of treatment of patients with infected necrotizing pancreatitis and its complication sonthebasis of continuous monitoring of bacterial flora with the provision of adequate antibiotic therapy, prevention of nosocominal infectionand a modern strategy for the use of surgical interventions, especiallynoninvasive, contributes to the reduction of sepsis and, as a result, reduction in mortality and severe postoperative complications.
References
Bondarenko OM. Justification of the differential approach to minimally invasive and open surgical interventions on the complications of acute pancreatitis. Klinichni khirurhiya. 2016; 5: 13–16.
Gelfand BR, Gelfand EB, Platonov EA et al. Antibacterial therapy of abdominal sepsis in surgical patients. Proceedings of the VII All-Russian Congress of aesthesiologists and resuscitators. St. Petersburg, 2000, p. 56.
Darwin VV, Onishchenko SV, Ilkanich AJ et al. Acute destructive pancreatitis: an analysis of traditional and minimally invasive interventions. Proceedings of the VII All-Russian Conference of Surgeons' Communities with international participation. Krasnoyarsk, 201, p. 78–81.
Dronov AI, Kovalska IA, Uvarov VY, Gorlach AI. Peculiarities of the pathogenetic approach to the treatment of acute necrotic pancreatitis. Ukrayinskyy zhurnal khirurhiyi. 2013; 3: 145–149.
Kopchak VM, Khomyak IV, Shevchenko VM et al. Algorithm of surgical treatment of acute pancreatitis. Klinichna khirurhiya. 2014; 9: 21–24.
Kotelnikova PL, Burnyshev IG, Kudryavtsev PL. Immediate and long-term results of treatment of aseptic and infected pancreatic necrosis. Sovremennyye problemy nauki i obrazovaniya. 2015; 6: 49.
Beger HG, Rau ВА, Isenmann R. Natural history of necrotizing pancreatitis. J Pancreatol. 2003; 3: 93–101. DOI:10.1159/000070076.
Dulce M, Taxonera С, Giner М. Up date on pathogenesis and clinical management of acute pancreatitis. World J Gastrointestinal Pathophysiol. 2012; 3 (3): 60–70. DOI: 10.4291/wjgp.v3.i3.60.
Petrov MS. Meta-analyses on the prophylactic use of antibiotic subacute pancreatitis: many are called but few are chosen. Am J Gastroenterol. 2008; 103 (7): 1837–1838. DOI: 10.1111/j.1572-0241.2008.01959_5.x.
