The algorithm based on procalcitonin can guide the use of antibiotics in acute pancreatitis

The measurement of this peptide can help detect infections.

Luisa Ochoa

August 01, 2022 | | Timo De Lectura: 5 min

Tanto chronic pancreatitis como la acute pueden hacer que el pancreas produzca menos enzymas que las necessarias para descomponer y procesar los nutrients de los alimentos. Photo: Shutterstock.

De acuerdo con los resultados de un ensayo aleatorio controlled, un algoritmo basado en la procalcitonin podría reducir de forma segura el uso innecesario de antibióticos en pacientes con Acute pancreatitis.

The researchers wrote in The Lancet Gastroenterology & Hepatology, that “the excessive use of antibiotics and the resulting appearance of microorganisms resistant to multiple drugs are a potent threat to the welfare of humanity in the XXI century”.

In addition, the principal author, Dr. Ajith K. Siriwardena, MD, indicated that doctors should consider incorporating the decision-making process into their daily practice.

The excessive use of antibiotics is common in cases Acute pancreatitis, the researchers affirmed, dueto a que las caracteristics clinicas suelen ser insufficientes para distinguishing between inflammation and infection. How do they fall? procalcitonin puede ayudar a detecter infections, la “indiscriminate medición” del biomarcador no es rentable, lo que lleva a las revisiones y analisis anteriores a concluar que se necesita más investigation antes de poder recomendar el uso generalizado.

Siriwardena and his colleagues tried to satisfy this need by means of the realization of an aleatory control trial in which 260 hospitalized patients participated. Acute pancreatitis.

Los pacientes fueron aleatorizados en una proportione cercana a 1:1. Both the intervention group and the control group received atención basada en las guías; sin embargo, además del estándar de atención, se midió la procalcitonin en el grupo de intervention los días 0, 4 y 7 y luego semanalmente. Entre estos pacientes, los antibióticos se suspendedieron o no commenzaron cuando la procalcitonin estaba por debajo de 1.0 ng/mL, pero los antibióticos se iniciaron o continuaron cuando la procalcitonin era de 1.0 ng/mL or más.

The primary result was the presence or absence of antibiotic use during the hospital stay. También se informó una variety of secondary results, including mortality for all causes, antibiotic use days, infection rates and endoscopic, radiological or surgical intervention.

Significantly, menos pacientes en el group de procalcitonin received antibiotics during their stay, compared to the habitual attention group (45% compared to 63%), which translates into a difference of risk adjustment of -15.6%. Los pacientes del group de procalcitonin they received antibiotics they received alrededor de 1 día menos de tratamiento con antibiotics.

“Los algoritmos basados ​​en procalcitonin before guiding the use of antibiotics, they must be considered in the care of this group of patients and incorporated in future guidelines on the handling of the Acute pancreatitis“, the researchers conclude.

Despite the reduced use of antibiotics, the duration of the hospital stay was similar between the groups, as were the rates of clinical infection, infection acquired in the hospital, death and adverse events, which suggests that the algorithm reduces safety el uso de antibiotics sin afectar negativamente los resultados clinicos, según researchers.

El Dr. Aaron Sasson, MD, director of the cancer center pancreas y codirector del equipo de oncología gastrointestinal de Stony Brook (NY) Medicine, dijo que el estudio es digno de mención porque aborda un tema importante con un gran ensayo aleatorio prospectivetivo; sin embargo, pointed out algunas limitaciones.

“Hay varios problemas con este juicio. Primero, incluyó un gran percentage de pacientes con Acute pancreatitis leve, un grupo de pacientes para quienes el uso de antibióticos no es controvertido. In the second place, the rate of infected pancreatic necrosis was 5% in both arms of the study, which indicates the lack of gravity in the cohort of patients.”

Sasson said that the algorithm “can be useful” before differentiating between inflammation and infection in patients with con Acute pancreatitis“pero solo como complemento de otros parametres clinicos”.

Sugirió que el algoritho ofrecería más utilização si pudiera distinguire entre la necrosis pancreática y la necrosis pancreática infectada. “Unfortunately, this trial did not respond to this question,” he said, adding that he would need a similar trial in which “solo patients with serious pancreatitis” participated.

Fuente consultada aquí.