In
acute pancreatitis, pancreatic
inflammation may be complicated by the development of pancreatic
infection with a high associated mortality. Pancreatic
infection is related to the extent of pancreatic
inflammation and
necrosis and typically occurs in the second or third week of severe disease. It may be associated with a wide range of Gram-positive and Gram-negative bacteria, notably enterobacteria and also with Candida spp. Current surgical practice in the UK is to use prophylactic antimicrobial
therapy in patients with severe disease, with the aim of preventing secondary pancreatic
infection. Experimental evidence demonstrates that prophylactic antibacterial
therapy prevents pancreatic
infection and reduces mortality. Furthermore, studies of antibacterial prophylaxis in patients with
acute pancreatitis suggest that prophylactic antibacterial
therapy is associated with a reduction in mortality, particularly in those with severe disease. In general, broad-spectrum
antibiotics have been used in animal and human studies. However, current evidence does not allow comparisons to be made between different
antimicrobial agents. Nutritional strategies may also be important in the prevention of pancreatic
infection. Enteral, rather than
parenteral, nutrition has been associated with an improved clinical outcome in severe
pancreatitis.