The high mortality (10–30%) of acute necrotising pancreatitis is bound up with (endogenous)
infection of the necrotic tissues. Changing this connection is the aim of conservative
treatment. Together with intensive care and enteral feeding, we used selective bowel
decontamination (SBD) which can prevent endogenous infections by reducing the number
of potentially pathogen microbes (aerobe bacteria, fungi) in the oropharynx and gastro-intestinal
tract, saving anaerobe bacteria. We considered its influence on mortality, frequency
of septic complications, number of invasive treatments needed and on hospitalization
time.
In our prospective, comparative, randomized study we included 20 patients so far,
half of them received SBD. Inclusion criteria were the serious general condition (APACHE
II. 10–25) and CT findings (Balthazar C, D, and E.) As systemic prevention group 1.
(APACHE II.=16) received imipenem/cilastatin, group 2. (APACHE II.=15.3) received
ceftazidime and metronidazol. Group 2 SBD gel (to gingiva) and suspension (into nasojejunal
tube) included amphotericin-B, norfloxacin and vancomycin. We proceeded with decontamination
for 2–4 weeks depending on the course of pancreatitis.
In our experience SBD was technically simple. Our patients had neither side effects,
nor an increase in microbial resistance. The decontamination suspension and gel must
be manufactured individually in the institutions, and can be stored for a short period,
which complicates the method. Though our number of patients does not give a definitive
basis to statistical analysis, we consider that SBD group had fewer septic complications,
shorter hospitalization (43 vs. 52 days), lower mortality rate (20% vs. 40%) and number
of invasive treatments per patient (1.3 vs. 2.3)
Early results of our trial suggest that selective decontamination assists preventing
serious septic complications, and helps interventional radiology to treat necrosis
successfully in increasing number of patients.
