Prevention of Infectious Complications in Acute Pancreatitis

Objectives This study aimed to investigate the efficiency of imipenem to prevent infectious complications in predicted severe acute pancreatitis (AP). Methods Consecutive AP patients were randomized to imipenem 3 × 500 mg intravenously daily or an identical placebo. Exclusion criteria were prior AP, chronic pancreatitis, active malignancy, immune deficiency, active infection, concomitant antibiotic treatment, pregnancy, and patients younger than 18 years. Infectious complications including infected pancreatic necrosis, pneumonia, urinary tract infection, positive blood cultures, sepsis, and other infections were assessed as the primary outcome. Secondary outcomes included mortality, persistent organ failure, systemic inflammatory response syndrome, local complications, serious adverse events, and need for surgical intervention. Results Forty-nine patients were randomized to each group. Infectious complications were present in 10 versus 12 of 49 patients (relative risk [RR], 0.833; 95% confidence interval [CI], 0.398–1.747). There were no significant differences in infected pancreatic necrosis (RR, 1.5; 95% CI, 0.262–8.588), pneumonia (RR, 1.5; 95% CI, 0.262–8.588), urinary tract infection (RR, 0.6; 95% CI, 0.152–2.374), positive blood cultures (RR, 0.5; 95% CI, 0.047–5.336), sepsis (RR, 0.333; 95% CI, 0.036–3.095), and other (RR, 1.333; 95% CI, 0.315–5.648). We found no significant differences in secondary outcomes. Conclusions Concordantly to available evidence, there is currently no ground to support prophylactic use of antibiotics in predicted severe AP.