706 An Audit of Antibiotic Prescribing in Acute Pancreatitis and Introduction of a Patient Safety and Cost Saving Diagnostic Tool

Abstract

Abstract Background In managing acute pancreatitis it is challenging to distinguish systemic inflammatory response syndrome (SIRS) from bacterial infection, contributing to inappropriate use of antibiotics, which are only recommended in cases of infected pancreatitis. Over prescribing of broad-spectrum antibiotics is associated with C. difficile, adverse reactions and antibiotic resistance, and has a cost implication. Procalcitonin (PCT) is sensitive (93%) and specific (79%) for diagnosing infected pancreatitis and recommended to guide antibiotic therapy. Method We performed a retrospective audit of the care received by 88 acute pancreatitis patients over 12-months. Results 19/52 (36.5%) with uncomplicated pancreatitis were prescribed antibiotics. 22/36 (61.1%) with infected pancreatitis or a secondary infection source received antibiotics. 36/41 (87.8%) were prescribed broad-spectrum IV antibiotics. Seven days of IV co-amoxiclav costs £15.80, excluding consumables or nursing staff/pharmacy time. A single PCT costs £9.64. Conclusions These results suggest inappropriate prescribing of antibiotics in managing acute pancreatitis. Where diagnostic uncertainty lies between acute uncomplicated pancreatitis with SIRS versus infected pancreatitis, PCT is a useful diagnostic tool to help guide antibiotic therapy, therefore improving patient safety and antibiotic stewardship, with cost benefits. Following this audit, our trust has approved PCT for use in acute pancreatitis, and future audits will assess ongoing antibiotic prescribing in this cohort.