Introduction
Infectious complications are a significant concern in Acute Pancreatitis (AP), contributing to increased morbidity and mortality. Antibiotics are crucial in their management and should be initiated when infection is suspected. However, their overuse can lead to complications and antimicrobial resistance.
Aims & Methods
The aim of this retrospective study is to evaluate antibiotic utilization in real-world practice within a Spanish cohort and identify clinical and laboratory factors associated with their use. Patients admitted to our tertiary center for acute pancreatitis were included. Clinical and laboratory parameters routinely used in acute pancreatitis were collected upon admission and after 48 hours. Any infections (mainly infected necrosis, acute cholangitis following Tokyo 2018 criteria, pneumonia, and urinary tract infections) were documented, and patients were followed until discharge or death. Poor outcomes, such as severe acute pancreatitis based on the Atlanta 2012 classification and death, were assessed in patients who received antibiotics and those who did not.
Results
211 patients were recruited from July 2017 to December 2017. 111 (52.6%) were women, and in 170 (61.8%) the etiology was biliary. Antibiotic therapy was used in 77 (36.5%) patients, 21 had severe acute pancreatitis (9.95%) and 11 died (5.21%). Comparison between patients to whom antibiotics were prescribed and those who did not are shown on Table 1. Variables included in the logistic regression were SIRS on admission, PCR > 150mg/dL after 48h, PCT >1 ng/ml on admission and BT> 3mg/dL on admission with the presence of SIRS and BT >3 mg/dl at admission proving to be significant in the end.
| N (%) | No antibiotics 134 (63,5%) | Need of antibiotics 77 (36,5%)
| P value |
| Leucocytes, mean (sd) | 12.642 (5.317)
| 14.390 (5.536)
| < 0,005
|
Procalcitonin > 1 ng/ml, n (%)
| 13 (11,6)
| 18 (26,5)
| < 0.01 |
| Total Bilirrubin , mean (sd) | 1.68 (1.84)
| 2.74 (2.57)
| 0,001
|
| C reactive protein after 48h, mean (sd) | 128 (112)
| 173 (129)
| 0,022
|
Temperature (Celsius), mean (sd)
| 36,2 (0,5)
| 36,3 (0,607)
| n.s |
SIRS, n (%)
| 13 (9.7)
| 29 (37.6)
| <0.001 |
| Extrapancreatic infection, n (%) | 4 (1,9)
| 25 (32.4)
| <0.001 |
Severe Acute Pancreatitis, n (%)
| 6 (4.4)
| 15 (19)
| 0.001
|
Death, n (%)
| 2 (1.4)
| 9 (11.6)
| 0.001
|
Table 1. Patient Characteristics: Comparison between patients with Indicated antibiotic therapy and those without antibiotic therapy
Conclusion
Antibiotic therapy is routinely used in AP due to infected necrosis, acute cholangitis, or extrapancreatic infections. However, the early inflammatory response typical in AP makes it troublesome to distinguish whether sepsis is occurring due to an extrapancreatic infection, leading to potential overuse of antibiotics. In our sample, antibiotics were used in 36.5% of patients, and those developed SAP and death more often. Among clinical and laboratory factors related to antibiotic use, only total bilirubin >3mg/dL and the presence of SIRS on admission were independently related to the need for antibiotics. However, it is possible that some patients with SIRS and high bilirubin on admission do not truly require antibiotics, as these changes can also be due to AP. Although procalcitonin has been positioned as a potential marker of infection and can guide the need for antibiotics, future research could explore other factors to better select patients without overt infection for empiric antibiotic therapy.