الفهرس 
Epidemiology and causes of acute pancreatitisOnly 14 pages are availabe for public view
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Abstract
Acute pancreatitis is an acute inflammatory disease of the pancreas. The severe form of acute pancreatitis is accompanied by higher risk of complications, and its mortality is higher.
Infection and septic complications are the major factors contributing to the poor outcome in acute severe pancreatitis associated with a substantial increase of morbidity and mortality. About one third of patients with severe acute pancreatitis develop infectious complications that may explain up to 50% of deaths.
The infection does not manifest in the first week of the disease and usually occurs after 14-22 days after the onset of AP in most cases, and this brought on the requirement of antibiotic prophylaxis. Many studies recommended the prophylactic and early use of antibiotics, recommending imipenem - cilastatin, even before the development of pancreatic necrosis. On the other hand, several studies didn’t find a benefit from prophylaxis, in addition to the development of hazards such as fungal superinfection and the development of multi-resistant bacteria.
Conventional microbiological blood culture methods may fail to yield positive results if the causative organism is fastidious in nature, cell dependent or has a fungal etiology even in patients with proven infected pancreatic tissue. It has been shown that polymerase chain reaction (PCR) is more sensitive than conventional blood cultures and can detect minimal amounts of microbial products in blood. The importance of PCR depends on establishing a relationship between the presence or absence of clinical infection and the presence of bacterial DNA in the blood. Also, it provides information about the nature of inflammatory response in acute pancreatitis when traditional methods fail to detect bacteria.
The aim of this work was to detect bacteramia in serum of patients with acute pancreatitis targeting 16s rRNA, as common bacterial gene, and using PCR analysis as a more accurate and sensitive method than conventional blood cultures. The results were then correlated with the clinical and laboratory data of the patients.
The present study included twenty newly diagnosed acute pancreatitis patients. All patients were subjected to complete history taking, clinical examination, radiological investigations including CT scan and abdominal ultrasonography, and full laboratory investigations including serum amylase, CRP and blood culture. 16s rRNA gene was detected using conventional PCR.
The results of the present study showed that:
- Acute pancreatitis is more prevalent in females and gall stones are the most common causes followed by post-ERCP.
- E. coli is the most common organism isolated from blood of acute pancreatitis patients.
- Positive PCR results are significantly higher than those of blood culture.
- All patients with positive blood culture showed positive 16s rRNA in their blood with significant positivity at day 2 & 3.
- The majority of positive PCR results were obtained from samples taken at the second day after admission, and most cases were caused by gall stones. All these cases recovered with no septic complications.
- All patients received prophylactic antibiotics showed negative blood culture and PCR results at day 1, while some had positive PCR results at day 2 &3.
- Most patients recovered, while few died from complications far from septic ones. So, the effect of prophylactic antibiotic therapy on reducing mortality couldn’t be assessed.
In this study, we found that the positivity of blood culture and presence of 16s rRNA in the blood were less in the group that received prophylactic antibiotic. Nevertheless, the effect of prophylactic antibiotics in preventing septic complications couldn’t be concluded as no necrotic complications developed in both groups. However, in order to correlate outcome of prophylactic antibiotic therapy to morbidity and mortality, a longitudinal study on a large number of patients is needed.