Beger H G, Rau B, Isenmann R, Schwarz M, Gansauge F, Poch B
Department of Surgery, University of Ulm, Ulm, Germany.
Pancreatology. 2005;5(1):10-9. doi: 10.1159/000084485. Epub 2005 Mar 15.
Severe acute pancreatitis is considered to be a subgroup of acute pancreatitis with the development of local and/or systemic complications. A significant correlation exists between the development of pancreatic necrosis, the frequency of bacterial contamination of necrosis and the evolution of systemic complications. Bacterial infection and the extent of necrosis are determinants for the outcome of severe acute pancreatitis. The late course of necrotizing pancreatitis is determined by bacterial infection of pancreatic and peripancreatic necroses. Mortality increases from 5-25% in patients with sterile necrosis to 15-28% when infection has occurred. The use of prophylactic antibiotics has been recommended in patients with necrotizing pancreatitis. Several controlled clinical trials demonstrated a significant reduction in pancreatic infections or a significant reduction of hospital mortality. However, the results of these clinical trials are controversial and not convincing. Recently, the largest randomized placebo-controlled, double-blind trial has been able to demonstrate that antibiotic prophylaxis with ciprofloxacin and metronidazole has no beneficial effects with regard to the reduction of pancreatic infection and the decrease of hospital mortality. The clinical data from this placebo-controlled trial do not support antibiotic prophylaxis in all patients with necrotizing pancreatitis, but in specific subgroups of patients with pancreatic necrosis and a complicated course.
重症急性胰腺炎被认为是急性胰腺炎的一个亚组，伴有局部和/或全身并发症的发生。胰腺坏死的发生、坏死灶细菌污染的频率与全身并发症的演变之间存在显著相关性。细菌感染和坏死程度是重症急性胰腺炎预后的决定因素。坏死性胰腺炎的后期病程取决于胰腺及胰周坏死灶的细菌感染。无菌性坏死患者的死亡率为5% - 25%，发生感染时死亡率升至15% - 28%。对于坏死性胰腺炎患者，推荐使用预防性抗生素。多项对照临床试验表明，胰腺感染显著减少或医院死亡率显著降低。然而，这些临床试验的结果存在争议且缺乏说服力。最近，规模最大的随机安慰剂对照双盲试验表明，环丙沙星和甲硝唑预防性使用抗生素在减少胰腺感染和降低医院死亡率方面并无有益效果。这项安慰剂对照试验的临床数据并不支持对所有坏死性胰腺炎患者进行抗生素预防，而是支持对胰腺坏死且病程复杂的特定亚组患者进行预防。
