Infections pancreatic necrosis

Antibiotic prophylaxis is not always effective in eliminating the risk of infected pancreatic necrosis. Widespread use of antibiotics may lead to multiresistant bacterial and fungal infections, thus worsening the course of the disease. There appears to be a shift toward gram-positive infections (primarily enterococci and staphylococci) in AP patients who receive antibiotic prophylaxis as compared to... 

Pancreatic necrosis occurs in patients with severe acute pancreatitis detected through perfusion defects in the contrast-enhanced CT. Therapeutic method of choice is surgical necrosectomy percutaneous drainage is not suitable. On the other hand, the differentiation of sterile from infected pancreatic necrosis is done by percutaneous sampling of the necrotic pancreatic parenchyma with a small-gauge needle (20 G). 

Acute pancreatitis can progress to several distinct consequences. Pancreatic fluid collections and pancreatic abscesses can form during the course of acute pancreatitis. Pancreatic necrosis can occur when pancreatic enzymes damage the pancreatic tissue or when pancreatic abscesses become secondarily infected. This infection is usually due to bacteria that are normally found in the gastrointestinal tract, including Escherichia coli, Enterobacteriaceae, Staphylococcus aureus, viridans group streptococci, and anaerobes. 

Pancreatic necrosis is a diffuse inflammation of the pancreas with infectious etiology. Pancreatic necrosis occurs within the first 2 weeks of acute pancreatitis and develops in 10% to 30% of patients with acute pancreatitis. The necrotic pancreas can become secondarily infected with enteric gramnegative bacteria (such as E. coli), and disseminated infection may result from pancreatic necrosis.7,8... 

Antibiotics are appropriate for pancreatic necrosis, which can be infected initially or be susceptible to a secondary infection.21 Selected intravenous antibiotic regimens are shown in Table 20-2. If necrosis is confirmed, antibiotics are insufficient as sole therapy surgical debridement is necessary for cure. 

Isenmann R, Beger HG Bacterial infection of pancreatic necrosis Role of bacterial translocation, impact of antibiotic treatment. Pan-creatology 2001 1 79-89. 

Treatment of AP is aimed at relieving abdominal pain and nausea, replacing fluids, minimizing systemic complications, and preventing pancreatic necrosis and infection. 

There have been over 50 published reports of acute pancreatitis associated with valproate (SEDA-18, 70) (84), including several confirmed by rechallenge. Deaths have occurred from hemorrhagic pancreatic necrosis complications can include pleural and pericardial effusions, coagulopathy, pseudocyst, ascites, wound infection, and pneumonia (SED-13, 151) (85). Hepatotoxicity can coexist. There is suggestive evidence that end-stage renal insufficiency (SEDA-22, 92) and mental retardation (84) can be predisposing factors. 

Antibiotics should not be used in the absence of signs of infection except in patients with severe acute pancreatitis when pancreatic necrosis is present. 

Local complications—including acute fluid collection, pancreatic necrosis, abscess, and pseudocyst (collection of pancreatic juice and tissue debris enclosed by a wall of fibrous or granulation tissue)— develop about 4 to 6 weeks after the initial attack. Pancreatic abscess is usually a secondary infection of necrotic tissue or pseudocysts and correlates with the severity of the pancreatitis. Most deaths result from... 

Enteral feedings may also prevent infection by decreasing translocation of bacteria across the gut wall. Preliminary data suggest that probiotics such as lactobacillus (along with a fiber supplement) may reduce bacterial translocation and possibly decrease pancreatic necrosis and abscess. If enteral feeding is not possible, total parenteral nutrition (TPN) should be implemented before protein and calorie depletion becomes advanced. Intravenous lipids should not be withheld unless the serum triglyceride concentration is greater than 500 mg/dL. At present, there is no clear evidence that nutritional support alters outcome in most patients with AP unless malnutrition exists. ... 

When possible, discontinue medications listed in Table 39-2. Antisecretory drugs may be used to prevent stress-related mucosal bleeding. Octreotide may be tried in severe AP, but its efficacy remains uncertain (see Pig. 39-3). Antibiotics should not be used in the absence of signs of infection except in patients with biliary tract gallstones, or in severe AP when pancreatic necrosis or abscess is... 

Birnavirus (infectious pancreatic necrosis virus of fish and infections bursal disease virus of fowl). 

MCBEATH Aj, SNOW M, sEcoMBES cj, ELLIS AE, COLLET B (2007), Expression kinetics of interferon and interferon-induced genes in Atlantic salmon (Salmo salar) following infection with infectious pancreatic necrosis virus and infectious salmon anaemia virus , Eish Shellfish Immunol, 22,230-41. 

GIBSON D R, SMAiL D A and SOMMERVILLE c (1998), Infectious pancreatic necrosis virus experimental infection of goldsinny wrasse, Ctenolabrus rupestris L. (Labridae), / Fish Dis, 21, 399 06. 

M19. Muller, C. A., Uhl, W., Printzen, G., Gloor, B., Bischofberger, H., Tcholakov, O., and Biichler, M. W., Role of procalcitonin and granulocyte colony stimulating factor in the early prediction of infected necrosis in severe acute pancreatitis. Gut 46,233—238 (2000). 

Other examinations focused on the biochemical differentiation of ascites, such as determining cholinesterase (62) and interleukin-6 (18) as sensitive parameters for bacterial infection as well as evaluating the receptors (p55 and p75) for the tumour necrosis factor. (19) An ascites/serum quotient for ai-foetoprotein of > 1 suggests hepatocellular carcinoma an amylase quotient of > 1 is found in pancreatitis. 

Some clinicians believe that antibiotic prophylaxis is necessary in patients with severe AP in order to prevent pancreatic infection, while others believe that this practice is unnecessary. Antibiotic use in AP remains controversial in patients without definite proof of an infection. Patients with severe AP complicated by necrosis should receive prophylactic treatment with a broad-spectrum antibiotic. 

Riche FD, Cholley BO, Laisne MJC, et al. Inflammatory cytokines, C reactive protein, and procalcitonin as early predictors of necrosis infection in acute necrotizing pancreatitis. Surgery 2003 133 257-262. 

Howard TJ, Temple MB. Prophylactic antibiotics alter the bacteriology of infected necrosis in severe acute pancreatitis. J Am Coll Surg 2002 195 759-767. 

According to Lee (2004), success rates of pancreatic abscess drainage range between 32% (infected necrosis) and 90% (pancreatic abscess). For complete drainage, often large and multiple catheters are required. 

Biological Applications Calcium indicatois zinc indicators treating acute cell death, cerebral infarction, myocardial infarction, hepatonecrosis, kidney ischemic necrosis, necrotizing pancreatitis, amyloidosis, atherosclerosis, diseases characterized by calcification and/or plaque formation, osteoporosis, Paget s disease, heterotropic ossification, hypercalce-mia, cancer, inflammation, diabetes mellitus, epilepsy, epithelial disorders, glaucoma, HIV-associated conditions, respiratory disorders, streptococcal infection, viral diseases ... 

Fig. 7.16. Image from a 44-year-old man obtained 9 months after simultaneous pancreas-kidney transplantation with graft necrosis but without local infection or sepsis and subsequent graft extirpation. Contrast-enhanced multidetector CT shows absent parenchymal enhancement and emphysematous transformation of pancreatic graft arrow) consistent with innocuous gas collection. Annotation renal graft black asterisk) and ascites white asterisk)...

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