Related Experiment Videos
Prevention of bacterial infection and sepsis in acute severe pancreatitis
P McClelland1, A Murray, M Yaqoob
1Renal Unit, Royal Liverpool Hospital.
Insights
Selective digestive decontamination (SDD) significantly reduced serious infections and sepsis in acute pancreatitis patients requiring ventilation. This approach may improve outcomes in this critical condition.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Gastroenterology
Background:
- Acute pancreatitis can lead to acute respiratory failure requiring intensive care unit (ICU) management.
- Patients with acute pancreatitis and respiratory failure are at high risk for serious infections and sepsis.
Purpose of the Study:
- To evaluate the impact of selective digestive decontamination (SDD) on infection and sepsis rates in patients with acute pancreatitis and respiratory failure.
Main Methods:
- A retrospective analysis of patients with acute pancreatitis and respiratory failure managed between 1984-1986 (pre-SDD) and 1987-1989 (with SDD).
- SDD involved enteral administration of tobramycin, polymyxin, and amphotericin.
- Infection rates, sepsis incidence, systemic antibiotic use, and mortality were compared between the two groups.
Main Results:
- The incidence of serious infections decreased from 5/6 patients before SDD to 1/9 patients during SDD (P < 0.05).
- Clinical signs of sepsis were significantly reduced in the SDD group (39% vs. 62% of the time, P < 0.001).
- Systemic antibiotic use was lower in the SDD group, although mortality rates remained similar (2/6 pre-SDD vs. 3/9 during SDD).
Conclusions:
- Selective digestive decontamination is effective in reducing serious infections and sepsis in critically ill patients with acute pancreatitis.
- SDD may offer a potential strategy to improve the prognosis of acute pancreatitis, a life-threatening condition.
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.