WTP3.7 Are we using antibiotics appropriately in acute pancreatitis?

Abstract

Abstract Aim To re-evaluate antibiotic use in the management of acute pancreatitis at our hospital. Method This retrospective closed loop audit incorporated patients with acute pancreatitis admitted to our hospital between 01/04/22 and 30/06/22. The initial audit was conducted in 2020. The gold standard was guidelines published by the World Society of Emergency Surgery (2019). Data sources included patient paper notes, and clinical results and prescribing software. Results 44 patients presented with acute pancreatitis during the re-audit period; 80 patients were included in the initial audit. 22 of the re-audit patients (50%) received antibiotics, compared with 47 patients (59.1%) in the initial audit. Co-amoxiclav was the most used antibiotic (10 re-audit patients, 46.2%). 19 of the re-audit patients (86.3%) receiving antibiotics had mild or moderate acute pancreatitis (on Modified Glasgow Score); whereas most patients (29, 61%) in the initial audit had severe pancreatitis. Procalcitonin was not measured prior to commencing antibiotics in either audit. Also, no re-audit patient had CT-confirmed evidence of infected pancreatic necrosis. 5 re-audit patients (21.4%) were treated appropriately with antibiotics for extra-pancreatic infection, including acute cholecystitis and hospital-acquired pneumonia. Conclusion Decisions to commence antibiotics in acute pancreatitis have generally been inattentive to guideline recommendations, with greater focus on clinical impression of patient condition and inflammatory markers, such as C reactive protein. However, inappropriate antibiotic use may not bring patient benefit and negatively affect clinical care, for example yielding Clostridium Difficile infection and antimicrobial resistance. Hence, we will now change practice and measure procalcitonin to inform decision-making about antibiotics in acute pancreatitis.