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Published on: July 5, 2013
The microbiology of infected pancreatic necrosis
Nicholas G Mowbray1, Bassam Ben-Ismaeil2, Mohammed Hammoda3
1Swansea University, Medical School, Singleton Park Campus, Swansea, SA2 8PP, UK.
Background:
Acute pancreatitis (AP) continues to cause significant morbidity and mortality, especially when it leads to infected pancreatic necrosis (IPN). Modern treatment of IPN frequently involves prolonged courses of antibiotics in combination with minimally invasive therapies. This study aimed to update the existing evidence base by identifying the pathogens causing IPN and therefore aid future selection of empirical antibiotics.
Methods:
Clinical data, including microbiology results, of consecutive patients with IPN undergoing minimally invasive necrosectomy at our institution between January 2009 and July 2016 were retrospectively reviewed.
Results:
The results of 40 patients (22 males and 18 females, median age 60 years) with IPN were reviewed. The etiology of AP was gallstones, alcohol, dyslipidemia and unknown in 31, 2, 2 and 5 patients, respectively. The most frequently identified microbes in microbiology cultures were Enterococcus faecalis and faecium (22.5% and 20.0%) and Escherichia coli (20.0%). In 19 cases the cultures grew multiple organisms. The antibiotics with the least resistance amongst the microbiota were teicoplanin (5.0%), linezolid (5.6%), ertapenem (6.5%), and meropenem (7.4%).
Conclusion:
The carbapenem antibiotics, ertapenem and meropenem provide good antimicrobial cover against the common, mainly enteral, microorganisms causing IPN. Culture and sensitivity results of acquired samples should be regularly reviewed to adjust prescribing and monitor for emergence of resistance.
Insights
Infected pancreatic necrosis (IPN) is often caused by enteral microbes. Carbapenem antibiotics like ertapenem and meropenem show low resistance, making them effective for treating IPN.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Microbiology
Background:
- Acute pancreatitis (AP) leads to significant morbidity and mortality, particularly when progressing to infected pancreatic necrosis (IPN).
- Current IPN treatment often involves extended antibiotic courses and minimally invasive procedures.
- Identifying causative pathogens is crucial for optimizing empirical antibiotic selection.
Purpose of the Study:
- To identify the common pathogens responsible for infected pancreatic necrosis (IPN).
- To guide the selection of empirical antibiotic therapy for IPN.
- To update the evidence on microbial patterns in IPN.
Main Methods:
- Retrospective review of clinical data and microbiology results.
- Analysis of consecutive patients with IPN undergoing minimally invasive necrosectomy.
- Data collected from January 2009 to July 2016.
Main Results:
- Enterococcus faecalis (22.5%), Enterococcus faecium (20.0%), and Escherichia coli (20.0%) were the most frequent microbes.
- Mixed microbial growth was observed in 19 out of 40 cases.
- Low antibiotic resistance rates were noted for teicoplanin (5.0%), linezolid (5.6%), ertapenem (6.5%), and meropenem (7.4%).
Conclusions:
- Carbapenem antibiotics (ertapenem, meropenem) offer effective coverage against common enteral pathogens in IPN.
- Regular review of culture and sensitivity data is essential for adjusting antibiotic prescriptions.
- Monitoring for emerging resistance is critical for effective IPN management.
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