Emergence of antibiotic resistance in infected pancreatic necrosis

Background: Overall, the use of antibiotics in the treatment of patients with severe acute pancreatitis has increased owing to the use of antibiotic prophylaxis. Hypothesis: The incidence of antibiotic-resistant (AB-R) bacteria in infected pancreatitis is related to prolonged antibiotic treatment and may affect outcome. Design: Case series. Setting: Fifty-six-bed intensive care unit of a tertiary care center. Patients: Forty-six consecutive patients with infected pancreatic necrosis. Main Outcome Measures: Occurrence rate of AB-R organisms in pancreatic infection, overall duration of antibiotic treatment prior to infection, and mortality, defined as inhospital mortality. Results: Infection with AB-R microorganisms was found in 24 (52%) of 46 patients. Primary infection was present in 7 patients; in 21 patients, nosocomial surinfection with AB-R organisms occurred. Patients with AB-R infections were treated with antibiotics for a longer period (24 vs 15 days, P<.05), while disease severity and the incidence of organ failure were not statistically significantly different. The intensive care unit stay was significantly longer in patients with AB-R infections (23 vs 31 days, P=.02). Mortality was not statistically significantly different in patients with AB-R infections (37% vs 28%, P=.23). Conclusions: The occurrence rate of infections with AB-R organisms in our patients with severe acute pancreatitis was high and was associated with a longer intensive care unit stay, but no increased mortality could be demonstrated. The duration of antibiotic treatment was increased in patients in whom AB-R infections developed.