Medical Education and Research, Maimonides Medical Center, State University of New York-Health Sciences Center, 2211 Emmons Avenue, Brooklyn, NY, 11235, USA.
Curr Infect Dis Rep. 2010 Jan;12(1):13-8. doi: 10.1007/s11908-009-0071-x.
Our understanding of the role of antibiotics in the management of patients with pancreatic necrosis has changed over the past 5 years. Initial studies suggested that antibiotics were useful in preventing infection of necrosis, septic complications, and mortality in patients with acute pancreatitis; however, more recent, better-designed studies established that prophylactic antibiotics are not helpful. In the absence of infection, sterile necrosis is treated conservatively. With insufficient evidence to recommend antibiotics, these agents should be reserved to treat established infection of pancreatic necrosis. Infected necrosis is treated by targeting microbes with pancreatic-penetrating antibiotics (eg, carbapenems, quinolones in combination with metronidazole, or high-dose cephalosporins). If the patient with infected necrosis remains septic or deteriorates, surgical intervention should be performed urgently. Stable patients with infected necrosis can be managed more conservatively in a closely monitored environment. Recent studies suggest that many patients can clear the infection with antibiotics, but even if they do not clear the infection, delay in surgery decreases the mortality rate. Delaying surgery by using antibiotics may allow use of less invasive procedures if drainage is needed. The timing and method of interventions must be individualized based on the patient's condition, anatomic complications, patient's preference after informed consent, and expertise available at the institution.
在过去的 5 年中，我们对抗生素在胰腺坏死患者治疗中的作用的理解发生了变化。最初的研究表明，抗生素在预防急性胰腺炎患者坏死感染、脓毒症并发症和死亡率方面是有用的；然而，最近设计更好的研究表明，预防性使用抗生素并没有帮助。在没有感染的情况下，无菌性坏死采用保守治疗。由于没有足够的证据推荐使用抗生素，这些药物应留作治疗已确诊的胰腺坏死感染。对于感染性坏死，通过使用具有胰腺穿透性的抗生素（如碳青霉烯类、与甲硝唑联合使用的喹诺酮类或高剂量头孢菌素类）靶向微生物进行治疗。如果患有感染性坏死的患者仍然有败血症或病情恶化，应紧急进行手术干预。对于感染性坏死的稳定患者，可以在密切监测的环境中更保守地进行管理。最近的研究表明，许多患者可以通过抗生素清除感染，但即使他们没有清除感染，如果延迟手术，死亡率也会降低。通过使用抗生素延迟手术，如果需要引流，可能会采用侵入性较小的程序。干预的时机和方法必须根据患者的病情、解剖学并发症、患者在知情同意后的偏好以及机构的专业知识进行个体化。
