[Strategy for bacterial translocation in acute pancreatitis]

Although bacterial translocation (BT) is thought to be a main cause of secondary pancreatic infection, the clinical significance is still unclear. Therefore, we investigated relationship between pancreatic infection and BT, analyzing the results of treatments such as continuous regional arterial infusion of protease inhibitor and antibiotics (CRAI), selective digestive decontamination, and early enteral nutrition (SDD/EN) in 45 severe acute pancreatitis patients. The infection rate of 17 cases without CRAI, SDD/EN was 58.8%, and mortality was 23.5%. Antibiotics-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) was often proven in infected pancreatic tissue. Whereas, in 16 cases who underwent both therapy, only one patient died of multi-organ failure (6.3%). Pseudomonas aeruginosa and K. pneumoniae were proven from his feces before pancreatic infection coincidence, and, in autopsy, these bacteria and MRSA were proved from necrotic pancreatic tissue. BT must be large cause of secondary pancreas infection, because CRAI and SDD/ EN prevent secondary pancreatic infection. But we must consider other infection routes, and development of antibiotics resistant bacteria.