ABSTRACT
OBJECTIVE: The aim of this study was to compare and validate the different classifications of severity in acute pancreatitis (AP) and to investigate which characteristics of the disease are associated with worse outcomes. SUMMARY OF BACKGROUND DATA: AP is a heterogeneous disease, ranging from uneventful cases to patients with considerable morbidity and high mortality rates. Severity classifications based on legitimate determinants of severity are important to correctly describe the course of disease. METHODS: A prospective multicenter cohort study involving patients with AP from 23 hospitals in Spain. The Atlanta Classification (AC), Revised Atlanta Classification (RAC), and Determinant-based Classification (DBC) were compared. Binary logistic multivariate analysis was performed to investigate independent determinants of severity. RESULTS: A total of 1655 patients were included; 70 patients (4.2%) died. RAC and DBC were equally superior to AC for describing the clinical course of AP. Although any kind of organ failure was associated with increased morbidity and mortality, persistent organ failure (POF) was the most significant determinant of severity. All local complications were associated with worse outcomes. Infected pancreatic necrosis correlated with high morbidity, but in the presence of POF, it was not associated to higher mortality when compared with sterile necrotizing pancreatitis. Exacerbation of previous comorbidity was associated with increased morbidity and mortality. CONCLUSION: The RAC and DBC both signify an advance in the description and differentiation of AP patients. Herein, we describe the complications of the disease independently associated to morbidity and mortality. Our findings are valuable not only when designing future studies on AP but also for the improvement of current classifications.
Subject(s)
Amylases/blood , Pancreatitis, Acute Necrotizing/diagnosis , Aged , Biomarkers/blood , Disease Progression , Female , Follow-Up Studies , Humans , Length of Stay/trends , Male , Middle Aged , Pancreatitis, Acute Necrotizing/blood , Pancreatitis, Acute Necrotizing/mortality , Prognosis , Prospective Studies , Severity of Illness Index , Spain/epidemiology , Survival Rate/trends , Tomography, X-Ray ComputedABSTRACT
The aim of our study was to determine whether rifampin resistance emerges in human skin staphylococci after oral intake of rifaximin for surgical prophylaxis. Rifampin-resistant staphylococci appeared on the skin of 32 out of 74 patients (43.2%) two weeks after prophylactic treatment with rifaximin. In all cases, the resistant strains were coagulase-negative staphylococci. The resistance completely reverted after three months. This study shows the emergence of transient resistance to rifampin after rifaximin intake.
Subject(s)
Antibiotic Prophylaxis/methods , Rifampin/therapeutic use , Rifaximin/therapeutic use , Staphylococcal Infections/prevention & control , Staphylococcus/drug effects , Administration, Oral , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Colorectal Surgery , Drug Resistance, Multiple, Bacterial/drug effects , Elective Surgical Procedures , Female , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Rifaximin/administration & dosage , Staphylococcal Infections/microbiology , Staphylococcus/isolation & purificationABSTRACT
La pancreatitis aguda (PA) tiene una incidencia creciente y es una de las enfermedades gastrointestinales que con más frecuencia requiere hospitalización. Numerosas evidencias científicas en los últimos años han comportado modificaciones importantes del tratamiento médico y quirúrgico de la PA. Los nuevos conocimientos sobre la fisiopatología de la enfermedad nos indican que la gravedad de la PA viene marcada por la repercusión sistémica que ocasiona (fallo orgánico), sobre todo si es persistente, y también por las complicaciones locales que se pueden desarrollar (colecciones líquidas o necrosis), especialmente si se infectan. El tratamiento ha de ser personalizado y la actuación dependerá de la situación clínica, la localización de la necrosis y el momento evolutivo en que se encuentre el paciente
The incidence of acute pancreatitis (AP) is increasing. AP is one of the gastrointestinal diseases that most frequently requires hospital admission in affected individuals. In the last few years, considerable scientific evidence has led to substantial changes in the medical and surgical treatment of this disease. New knowledge of the physiopathology of AP indicates that its severity is influenced by its systemic effects (organ failure), especially if the disease is persistent, and also by local complications (fluid collections or necrosis), especially if these become infected. Treatment should be personalized and depends on the patient's clinical status, the location of the necrosis, and disease stage
Subject(s)
Humans , Pancreatitis, Acute Necrotizing/diagnosis , Pancreatitis, Acute Necrotizing/therapy , Practice Patterns, Physicians' , Amylases/blood , Lipase/blood , Tomography, X-Ray Computed , Severity of Illness Index , Risk FactorsABSTRACT
The incidence of acute pancreatitis (AP) is increasing. AP is one of the gastrointestinal diseases that most frequently requires hospital admission in affected individuals. In the last few years, considerable scientific evidence has led to substantial changes in the medical and surgical treatment of this disease. New knowledge of the physiopathology of AP indicates that its severity is influenced by its systemic effects (organ failure), especially if the disease is persistent, and also by local complications (fluid collections or necrosis), especially if these become infected. Treatment should be personalized and depends on the patient's clinical status, the location of the necrosis, and disease stage.
Subject(s)
Pancreatitis/therapy , Acute Disease , Analgesia/methods , Cholangiopancreatography, Endoscopic Retrograde , Cholelithiasis/complications , Disease Management , Drainage , Exocrine Pancreatic Insufficiency/etiology , Humans , Intra-Abdominal Hypertension/etiology , Intra-Abdominal Hypertension/prevention & control , Multiple Organ Failure/etiology , Necrosis , Nutritional Support , Pancreatic Pseudocyst/etiology , Pancreatitis/complications , Pancreatitis/diagnostic imaging , Pancreatitis/physiopathology , Prognosis , Risk Factors , Thrombophilia/drug therapy , Thrombophilia/etiologyABSTRACT
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