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Guidelines
Pancreatitis, Infected Necrotizing

Pancreatitis, Infected Necrotizing

Guideline Use

This guideline is not intended for the treatment of Severe Sepsis/Septic Shock
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Utilize the Severe Sepsis/Septic Shock guidelines

Dose recommendations are based on patients with normal renal function. Refer to dosing in renal impairment

These guidelines may not be appropriate for patients with a history of multi-drug resistant organisms. Consider infectious disease consultation

Diagnostics

Antibiotic selection should be guided by cultures where available; empiric choices in this guideline are based on local susceptibilities

  • Signs/Symptoms:
    • ↑ WBC, fever, hypotension common in severe pancreatitis with and without infection
  • Radiographic Imaging:
    • Both infected and non-infected pancreatitis may have walled-off cysts or pseudocysts with peripancreatic or pancreatic necrosis

Consider infected necrotizing pancreatitis if:

  • Fine-needle aspiration and culture reveals organisms
  • Gas evident on imagining
  • 7-10 days of appropriate supportive care with continued deterioration

Management Considerations

Prophylactic antibiotics are not recommended and do not improve outcomes

Yeast, if isolated, should be treated

Treatment

No Signs/Symptoms of Infection
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  • WBC ≤ 12.5
  • Temperature ≤ 38.5ºC
  • No radiographic signs of rupture, abscess, or gas

Post-Surgical/Health-Care Associated
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  • Hospitalized > 48 hours
  • Post-operative

Additional Information

These recommendations are meant to guide empiric therapeutic decision making and are not meant to replace sound clinical decision making. Definitive therapy should be based on culture and susceptibility reports

  • Kyle D. Massey, PharmD

  • Rebekah Gass, MD

  • Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010; 50: 133-64. Pubmed
  • Regimbeau JM, Fuks D, Pautrat K, et al., for the FRENCH Study Group. Effect of postoperative antibiotic administration on postoperative infection following cholecystectomy for acute calculous cholecystitis: a randomized clinical trial. JAMA 2014; 312: 145-54. Pubmed
  • Mazuki JE, Tessier JM, May AK, et al. The surgical infection society revised guidelines on the management of intra-abdominal infection. Surgical infections 2017; 18: 1-76. Pubmed
  • Sawyer RG, Claridge JA, Nathens AB et al. Trial of short-course antimicrobial therapy for intraabdominal infection. NEJM 2015; 372: 1996-2005. Pubmed