Infectious Diseases I
If infection is confirmed, antibiotic therapy should be de-escalated toward the identified
pathogen(s) according to antibiotic susceptibility.
vi.
Definitive antibiotic therapy for confirmed infection should be continued for up to 14 days.
Prophylactic antimicrobial therapy in patients with sterile necrotizing pancreatitis is controversial.
Although small pilot investigations suggest benefit, a large, noninferiority, placebo-controlled
trial suggested no benefit with prophylactic meropenem. Current recommendations do not support
routine use of prophylactic antibiotic or antifungal therapy in patients with sterile necrotizing
Emerg Surg 2019;14:27)
Ongoing assessment of resolution of SIRS, trending of procalcitonin, and pancreatitis-associated
organ failure is imperative. Serial assessment of serum amylase or lipase has limited value over
clinical assessment and physical examination. Elevation of serum amylase or lipase for several weeks,
however, should heighten concern for persistent pancreatic/peripancreatic inflammation, blockage of
the pancreatic duct, or development of a pseudocyst.
Patient Cases
from home with acute, severe epigastric abdominal pain; heart rate 142 beats/minute; MAP 62 mm Hg;
WBC 24 x 103 cells/mm3; and serum lipase 1527 U/L. R.P. receives 3 L of normal saline intravenously over
60 minutes. An immediate abdominal CT scan is remarkable for significant pancreatic edema and greater
than 30% necrosis of the pancreas. There is no evidence of an acute fluid collection. Which antimicrobial
regimen would be most appropriate for R.P.?
acute pancreatitis and associated respiratory failure, SIRS, and blood pressure 100/55 mm Hg. Admission
abdominal CT shows severe pancreatitis with about 30% necrosis and a large focal fluid collection requiring
guided drainage. A fluid sample is sent for a Gram stain, which reveals many gram-negative rods and yeast.
Which antimicrobial regimen would best be initiated in T.J.?
C. difficile (also known as Clostridioides difficile) is a spore-forming, anaerobic, gram-positive bacillus.
Stool carriage of C. difficile has been found in up to 26% of acute care patients.