Naslov
Imipenem prophylaxis for predicted severe acute pancreatitis - preliminary results of a randomized clinical trial

Autori
Poropat, Goran ; Giljača, Vanja ; Licul, Vanja ; Hauser, Goran ; Milić, Sandra ; Štimac, Davor

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, pp prezentacija, znanstveni

Izvornik
7. kongres Hrvatskog gastroenterološkog društva s međunarodnim sudjelovanjem / - , 2015

Skup
7. kongres Hrvatskog gastroenterološkog društva s međunarodnim sudjelovanjem

Mjesto i datum
Opatija, Hrvatska, 01.10.2015. - 04.10.2015

Vrsta sudjelovanja
Poster

Vrsta recenzije
Domaća recenzija

Ključne riječi
Acute pancreatitis; Antibiotic prophylaxis

Sažetak
Introduction: Infected necrosis is a serious complication of acute pancreatitis leading to a mortality rate of about 40%1. Although prophylactic antibiotics are not recommended, meta-analytic data show that imipenem significantly reduces the rate of infected necrosis1. Aims & Methods: The aim of our study is to evaluate the prophylactic use of imipenem in patients with predicted severe acute pancreatitis. We conducted a prospective randomized trial in a tertiary care setting in Rijeka. Patients with AP and an APACHE II ≥ 8 were randomized to receive either imipenem 500 mg i.v. three times daily for the first ten days or an identical placebo. Exclusion criteria included age < 18 years, any infection present at admission, chronic pancreatitis, active malignancy, immunodeficiency, post-surgical patients, pregnant and breastfeeding women and patients unwilling to participate in the study. All patients received early enteral nutrition administered via a nasojejunal tube. Concomitant treatment was similar in both groups. All patients had an abdominal CT scan performed between days 3 to 7, and in cases of clinically suspected infected pancreatic necrosis. Results: Forty-seven consecutive patients were randomized. Twenty-three received imipenem and 24 received placebo. Three patients died in the imipenem group, while two patients died in the placebo group (p=0, 667). There were no differences in the occurrence of infected necrosis, with 2 vs. 3 cases, respectively. Other local complications were present in 7 and 13 patients (p=0, 142), while persistent organ failure was present in 4 and 5 patients (p=1, 00) in the imipenem and placebo group, respectively. Other infection were detected in 2 patients receiving imipenem and 5 patients on placebo (p=0, 416). Conclusion: Preliminary data showed no significant beneficial effects of prophylactic imipenem use in patients with predicted severe acute pancreatitis. References: 1Villatoro E, Mulla M, Larvin M. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database of Systematic Reviews 2010 ; 5:CD002941.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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