Antibiotic therapy in acute pancreatitis: From global overuse to evidence based recommendations.

Acute Disease Anti-Bacterial Agents / therapeutic use Antimicrobial Stewardship Bacterial Infections / complications Biomarkers Clinical Decision-Making Consensus Evidence-Based Medicine Guideline Adherence Humans Pancreatitis / complications Practice Patterns, Physicians' Randomized Controlled Trials as Topic Surveys and Questionnaires

Acute pancreatitis Antibiotic Guideline Infection Recommendation

Journal

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]

ISSN: 1424-3911

Titre abrégé: Pancreatology

Pays: Switzerland

ID NLM: 100966936

Informations de publication

Date de publication:
Jun 2019

Historique:

received: 31 03 2019

accepted: 01 04 2019

pubmed: 10 5 2019

medline: 31 12 2019

entrez: 10 5 2019

Statut: ppublish

Résumé

Unwarranted administration of antibiotics in acute pancreatitis presents a global challenge. The clinical reasoning behind the misuse is poorly understood. Our aim was to investigate current clinical practices and develop recommendations that guide clinicians in prescribing antibiotic treatment in acute pancreatitis. Four methods were used. 1) Systematic data collection was performed to summarize current evidence; 2) a retrospective questionnaire was developed to understand the current global clinical practice; 3) five years of prospectively collected data were analysed to identify the clinical parameters used by medical teams in the decision making process, and finally; 4) the UpToDate Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was applied to provide evidence based recommendations for healthcare professionals. The systematic literature search revealed no consensus on the start of AB therapy in patients with no bacterial culture test. Retrospective data collection on 9728 patients from 22 countries indicated a wide range (31-82%) of antibiotic use frequency in AP. Analysis of 56 variables from 962 patients showed that clinicians initiate antibiotic therapy based on increased WBC and/or elevated CRP, lipase and amylase levels. The above mentioned four laboratory parameters showed no association with infection in the early phase of acute pancreatitis. Instead, procalcitonin levels proved to be a better biomarker of early infection. Patients with suspected infection because of fever had no benefit from antibiotic therapy. The authors formulated four consensus statements to urge reduction of unjustified antibiotic treatment in acute pancreatitis and to use procalcitonin rather than WBC or CRP as biomarkers to guide decision-making.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

Four methods were used. 1) Systematic data collection was performed to summarize current evidence; 2) a retrospective questionnaire was developed to understand the current global clinical practice; 3) five years of prospectively collected data were analysed to identify the clinical parameters used by medical teams in the decision making process, and finally; 4) the UpToDate Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was applied to provide evidence based recommendations for healthcare professionals.

RESULTS RESULTS

The systematic literature search revealed no consensus on the start of AB therapy in patients with no bacterial culture test. Retrospective data collection on 9728 patients from 22 countries indicated a wide range (31-82%) of antibiotic use frequency in AP. Analysis of 56 variables from 962 patients showed that clinicians initiate antibiotic therapy based on increased WBC and/or elevated CRP, lipase and amylase levels. The above mentioned four laboratory parameters showed no association with infection in the early phase of acute pancreatitis. Instead, procalcitonin levels proved to be a better biomarker of early infection. Patients with suspected infection because of fever had no benefit from antibiotic therapy.

CONCLUSIONS CONCLUSIONS

The authors formulated four consensus statements to urge reduction of unjustified antibiotic treatment in acute pancreatitis and to use procalcitonin rather than WBC or CRP as biomarkers to guide decision-making.

Identifiants

DOI: 10.1016/j.pan.2019.04.003 PMID: 31068256

pubmed: 31068256

pii: S1424-3903(19)30091-2

doi: 10.1016/j.pan.2019.04.003

pii:

doi:

Substances chimiques

Anti-Bacterial Agents 0

Biomarkers 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

488-499

Subventions

Organisme : Department of Health

ID : EME/15/20/01

Pays : United Kingdom