BackgroundRecent international guidelines for acute pancreatitis (AP) recommend limiting anti-infective therapy (AIT) to cases of suspected necrotizing AP or nosocomial extrapancreatic infection. Limited data are available concerning empirical and documented AIT prescribing practices in patients admitted to the intensive care unit (ICU) for the management of AP.MethodsUsing a multicentre, retrospective (2009–2014), observational database of ICU patients admitted for AP, our primary objective was to assess the incidence of AIT prescribing practices during the first 30 days following admission. Secondary objectives were to assess the independent impact of centre characteristics on the incidence of AIT and to identify factors associated with crude hospital mortality in a logistic regression model.ResultsIn this cohort of 860 patients, 359 (42%) received AIT on admission. Before day 30, 340/359 (95%) AIT patients and 226/501 (45%) AIT-free patients on admission received additional AIT, mainly for intra-abdominal and lung infections. A large heterogeneity was observed between centres in terms of the incidence of infections, therapeutic management including AIT and prognosis. Administration of AIT on admission or until day 30 was not associated with an increased mortality rate. Patients receiving AIT on admission had increased rates of complications (septic shock, intra-abdominal and pulmonary infections), therapeutic (surgical, percutaneous, endoscopic) interventions and increased length of ICU stay compared to AIT-free patients. Patients receiving delayed AIT after admission and until day 30 had increased rates of complications (respiratory distress syndrome, intra-abdominal and pulmonary infections), therapeutic interventions and increased length of ICU stay compared to those receiving AIT on admission. Risk factors for hospital mortality assessed on admission were age (adjusted odds ratio [95% confidence interval] 1.03 [1.02–1.05]; p < 0.0001), Balthazar score E (2.26 [1.43–3.56]; p < 0.0001), oliguria/anuria (2.18 [1.82–4.33]; p < 0.0001), vasoactive support (2.83 [1.73–4.62]; p < 0.0001) and mechanical ventilation (1.90 [1.15–3.14]; p = 0.011), but not AIT (0.63 [0.40–1.01]; p = 0.057).ConclusionsHigh proportions of ICU patients admitted for AP receive AIT, both on admission and during their ICU stay. A large heterogeneity was observed between centres in terms of incidence of infections, AIT prescribing practices, therapeutic management and outcome. AIT reflects the initial severity and complications of AP, but is not a risk factor for death.

中文翻译：

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急性胰腺炎期间 ICU 抗感染治疗的流行病学和预后：一项队列研究


背景最近的急性胰腺炎（AP）国际指南建议将抗感染治疗（AIT）限制在疑似坏死性AP或医院内胰外感染的病例中。关于入住重症监护病房 (ICU) 治疗 AP 的患者的经验和记录的 AIT 处方实践的数据有限。方法使用多中心、回顾性（2009-2014 年）收治 AP 的 ICU 患者观察数据库，我们的主要研究目的是评估入院后前 30 天内 AIT 处方实践的发生率。次要目标是评估中心特征对 AIT 发生率的独立影响，并在逻辑回归模型中确定与粗医院死亡率相关的因素。 结果 在这个由 860 名患者组成的队列中，359 名患者 (42%) 在入院时接受了 AIT。在第 30 天之前，340/359 (95%) 例 AIT 患者和 226/501 (45%) 入院时未接受 AIT 的患者接受了额外的 AIT，主要用于治疗腹内和肺部感染。在感染发生率、包括 AIT 在内的治疗管理和预后方面，各中心之间观察到很大的异质性。入院时或直至第 30 天服用 AIT 与死亡率增加无关。与未接受 AIT 的患者相比，入院时接受 AIT 的患者并发症（感染性休克、腹内和肺部感染）、治疗（手术、经皮、内窥镜）干预发生率增加，并且 ICU 住院时间增加。 与入院时接受 AIT 的患者相比，入院后至第 30 天接受延迟 AIT 的患者并发症（呼吸窘迫综合征、腹内和肺部感染）、治疗干预和 ICU 住院时间增加的发生率增加。入院时评估的医院死亡率的危险因素包括年龄（调整后比值比 [95% 置信区间] 1.03 [1.02–1.05]；p < 0.0001）、Balthazar 评分 E（2.26 [1.43–3.56]；p < 0.0001）、少尿/无尿 (2.18 [1.82–4.33]; p < 0.0001)、血管活性支持 (2.83 [1.73–4.62]; p < 0.0001) 和机械通气 (1.90 [1.15–3.14]; p = 0.011)，但不是AIT (0.63 [0.40–1.01]; p = 0.057)。结论 因 AP 入院的 ICU 患者在入院时和 ICU 住院期间接受 AIT 的比例很高。在感染发生率、AIT 处方实践、治疗管理和结果方面，各中心之间观察到很大的异质性。 AIT 反映了 AP 的初始严重程度和并发症，但不是死亡的危险因素。