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Early antibiotic treatment (prophylaxis) of septic complications in severe acute necrotizing pancreatitis: a prospective, randomized, multicenter study comparing two regimens with imipenem-cilastatin.
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- Author(s): Maraví-Poma, Enrique; Gener, Joan; Alvarez-Lerma, Francisco; Olaechea, Pedro; Blanco, Armando; Domínguez-Muñoz, J. Enrique; Maraví-Poma, Enrique; Domínguez-Muñoz, J Enrique; Spanish Group for the Study of Septic Complications in Severe Acute Pancreatitis
- Source:
Intensive Care Medicine; Nov2003, Vol. 29 Issue 11, p1974-1980, 7p- Subject Terms:
PANCREATITIS; ANTIBIOTICS; THERAPEUTICS; MORTALITY; CRITICAL care medicine; INTENSIVE care units; SEPTICEMIA prevention; CROSS infection prevention; APACHE (Disease classification system); COMBINATION drug therapy; PREVENTION of communicable diseases; COMPARATIVE studies; COMPUTED tomography; CROSS infection; CAUSES of death; DRUG administration; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; NECROTIZING pancreatitis; RESEARCH; STATISTICAL sampling; SEPSIS; TIME; EVALUATION research; RANDOMIZED controlled trials; TREATMENT effectiveness; DISEASE incidence; SEVERITY of illness index; HOSPITAL mortality; ANTIBIOTIC prophylaxis; CILASTATIN; IMIPENEM; DISEASE complications; DIAGNOSIS - Source:
- Additional Information
- Subject Terms:
- Abstract:
Objective: We compared two imipenem regimens for prevention of septic complications in patients with severe acute necrotizing pancreatitis (ANP).Design and Setting: Prospective, randomized open clinical trial involving intensive care units of 14 Spanish Hospitals.Participants: 92 patients with ANP.Interventions: Imipenem/cilastatin was administered at 500 mg four times daily starting at the time of diagnosis of ANP, within the first 96 h from the onset of symptoms. Patients were randomized to receive antibiotic prophylaxis either for 14 days (group 1) or at least for 14 days and as long as major systemic complications of the disease persisted (group 2).Results: Antibiotic was maintained in group 2 for 19.7+/-10.9 days. The incidence of infected pancreatic necrosis, pancreatic abscess, and extrapancreatic infections was 11%, 17%, and 28% in group 1 and 17.4%, 13%, and 35% in group 2 (n.s.). Pancreatic or extrapancreatic infection by Candida albicans occurred in 7% and 22% of patients. Global mortality was 18.5% (10.9% secondary to septic complications), without differences between groups. In patients with persisting systemic complications at day 14 mortality was almost always secondary to septic complications and decreased from 25% (group 1) to 8.8% (group 2) by maintaining antibiotic prophylaxis.Conclusions: Compared to a 14-day imipenem prophylaxis, a longer antibiotic administration in patients with ANP is not associated with a reduction in the incidence of septic complications of the disease. However, prolonged imipenem administration in patients with persisting systemic complications tends to reduce mortality in ANP compared to a 14-days regimen. [ABSTRACT FROM AUTHOR] - Abstract: Copyright of Intensive Care Medicine is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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