FEATURES OF ANTIBIOTIC THERAPY IN PATIENTS WITH A COMPLICATED COURSE OF ACUTE PANCREATITIS

Abstract

Background. The most common cause of death among patients with acute pancreatitis in the late period of the disease is purulent-septic complications, which occur in 30-50% of cases.
 Aim: To study of the spectrum of microorganisms in the complicated course of acute pancreatitis and justification of the appointment of antibiotic therapy, taking into account the role of Helicobacter pylori as a pathogenetic factor of the disease.
 Materials and methods: 280 patients with acute pancreatitis participated in the study, who were divided depending on the treatment tactics into the main (n=140) and comparison group (n=139). To assess the effectiveness of surgical tactics in the studied groups, a comparative analysis of the frequency of development of purulent-septic complications and the species composition of microorganisms based on the results of bacteriological examination of biological fluids was carried out.
 Results. The species composition of microorganisms in case of purulent-septic complications in patients with severe acute pancreatitis is represented mainly by gram-negative flora (Escherichia coli, Pseudomonas aeruginosa, Acinetobacter spp., Klebsiella pneumoniae) with low sensitivity to most antibiotics, with the exception of protected semi-synthetic broad-spectrum antibiotics from the group penicillins and imipenem-cilastatin. When analyzing the studied indicators in the main group, an increase in the content of immunoglobulin M to Helicobacter pylori was detected in 41.1% (39/95) of patients with a severe course of the disease within 3 weeks from the moment of hospitalization. The use of generally accepted schemes of antibacterial therapy in combination with proton pump inhibitors for the treatment of purulent-septic complications of acute pancreatitis, taking into account the sensitivity of Helicobacter pylori to them, is not inferior to standard anti-Helicobacter treatment in terms of eradication effect (eradication was achieved in 94.9% of patients).
 Conclusions. The use of improved methods of diagnosis and treatment, including the justified appointment of antibiotic therapy taking into account Helicobacter pylori infection, made it possible to significantly reduce the frequency of development of purulent-septic complications by 18.1% (χ2=7.67, 95% CI 5.30 -30.20, p=0.005) and the number of microbial associations in the studied biological fluids by 51.3% (χ2=37.62, 95% CI 37.15-61.44, p<0.0001).