Abstracts
1999 Digestive Disease Week

# 2149 ACUTE NECROTIZING PANCREATITIS: IMPACT OF ANTIBIOTIC-PROPHYLAXIS ON TYPE AND FREQUENCY OF MICROBIOLOGICAL CONTAMINATION AND OUTCOME
Beat Gloor, W Uhl, Visceral and Transplant Surg, Inselspital, Bern Switzerland; C A Mueller, Inselspital, Bern Switzerland; G Mai, O Tcholakov, M Tauber, Visceral and Transplant Surg, Inselspital, Bern Switzerland; Markus W Buechler, Univ of Bern, Bern Switzerland

Background: Today, infectious complications contribute to 80% of all deaths in patients with acute pancreatitis. Hence, in patients with necrotizing pancreatitis (NP) prophylactic antibiotics are increasingly used. Methods: In a prospective study we administered imipenem/cilastatin prophylactically to all patients with NP as soon as the diagnosis was established by contrast-enhanced computed tomography. Antibiotics were given i.v. for 14 days (500 mg tid). Patients with NP and not receiving prophylactic antibiotics entered into previous prospective studies served as controls (Gastroenterology 1986;91:433-8; Gastroenterology 1987;93:1315-20; Surg Res Comm 1989;5:1-4). The spectrum of microorganisms cultured from necrotic pancreatic tissue and mortality were analyzed in both groups. Statistics: Chi-square and log-rank test. Results: There was no difference between the two groups with respect to gender, age etiology, and severity (Ranson and APACHE II score) of the attack. However, the spectrum of the microorganisms isolated from necrotic pancreatic tissue differed considerably and mortality was less in the group receiving antibiotics. Conclusions: Routine imipenem/cilastatin prophylaxis decreased the number of gram-negative infected necrosis thereby increasing the number of gram-positive infections of the necrotic tissue of the pancreas. In this study the germ-shift was associated with a decrease in mortality as compared to historical controls.

Antibiotic prophylaxis	Yes	No
Patients with NP	74	322
Infected necrosis	25/74 (37%)	274/322 (54%)	p<0.0034
Gram positive	21/25 (84%)	39/174 (22%)	p<0.00001
Gram negative	10/25 (40%)	123/174 (71%)	p=0.005
Anaerobes	1/25 (4%)	21/174 (12%)	p=0.39
Fungi	9/25 (36%)	10/174 (6%)	P<0.00001
Mortality	6/74 (8%)	23/114* (20%)	p=0.042
*Gastroenterology 1986;91:433-8.

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