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Early antibiotic treatment (prophylaxis) of septic complications in severe acute necrotizing pancreatitis: a prospective, randomized, multicenter study comparing two regimens with imipenem-cilastatin

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Abstract

Objective

We compared two imipenem regimens for prevention of septic complications in patients with severe acute necrotizing pancreatitis (ANP).

Design and setting

Prospective, randomized open clinical trial involving intensive care units of 14 Spanish Hospitals.

Participants

92 patients with ANP.

Interventions

Imipenem/cilastatin was administered at 500 mg four times daily starting at the time of diagnosis of ANP, within the first 96 h from the onset of symptoms. Patients were randomized to receive antibiotic prophylaxis either for 14 days (group 1) or at least for 14 days and as long as major systemic complications of the disease persisted (group 2).

Results

Antibiotic was maintained in group 2 for 19.7±10.9 days. The incidence of infected pancreatic necrosis, pancreatic abscess, and extrapancreatic infections was 11%, 17%, and 28% in group 1 and 17.4%, 13%, and 35% in group 2 (n.s.). Pancreatic or extrapancreatic infection by Candida albicans occurred in 7% and 22% of patients. Global mortality was 18.5% (10.9% secondary to septic complications), without differences between groups. In patients with persisting systemic complications at day 14 mortality was almost always secondary to septic complications and decreased from 25% (group 1) to 8.8% (group 2) by maintaining antibiotic prophylaxis.

Conclusions

Compared to a 14-day imipenem prophylaxis, a longer antibiotic administration in patients with ANP is not associated with a reduction in the incidence of septic complications of the disease. However, prolonged imipenem administration in patients with persisting systemic complications tends to reduce mortality in ANP compared to a 14-days regimen.

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Acknowledgements

The authors thank Dr. Jesus García de Jalón and Dr. Federico Repáraz Abaitua from the Department of Preventive Medicine of the Virgen del Camino Hospital of Pamplona and García Orcoyen Hospital of Estella, respectively, for technical assistance in the statistical evaluation. We also thank Mr. Robert Kimball from the Inasa Sales Department for his valuable contribution in writing the manuscript and for translation into English.

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Authors and Affiliations

  1. ICU, Servicio Navarro de Salud-Osasunbidea, Hospital Virgen del Camino, Irunlarrea 4, 31002, Pamplona, Spain

    Enrique Maraví-Poma

  2. ICU, German i Pujol Hospital, Badalona, Spain

    Joan Gener

  3. ICU, Hospital del Mar, Barcelona, Spain

    Francisco Alvarez-Lerma

  4. ICU, Galdakao Hospital, Bizkaia, Spain

    Pedro Olaechea

  5. ICU, Central Hospital of Asturias, Oviedo, Spain

    Armando Blanco

  6. Department of Gastroenterology, University Hospital, Santiago de Compostela, Spain

    J. Enrique Domínguez-Muñoz

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  1. Enrique Maraví-Poma
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  2. Joan Gener
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  3. Francisco Alvarez-Lerma
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  4. Pedro Olaechea
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  5. Armando Blanco
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  6. J. Enrique Domínguez-Muñoz
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Consortia

Spanish Group for the Study of Septic Complications in Severe Acute Pancreatitis

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Correspondence to Enrique Maraví-Poma.

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Maraví-Poma, E., Gener, J., Alvarez-Lerma, F. et al. Early antibiotic treatment (prophylaxis) of septic complications in severe acute necrotizing pancreatitis: a prospective, randomized, multicenter study comparing two regimens with imipenem-cilastatin. Intensive Care Med 29, 1974–1980 (2003). https://doi.org/10.1007/s00134-003-1956-z

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  • DOI: https://doi.org/10.1007/s00134-003-1956-z

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