Clinical Efficacy Analysis Of Antibiotic Use At Different Time Points In Severe Acute Pancreatitis With Hypertriglyceridemia

Objective To explore the clinical effect of different application time of antibiotics treatment in patients with hypertriglyceridemic severe acute Pancreatitis （HTG-SAP）.Methods The clinical data of patients with HTG-SAP admitted to the Department of Critical Care Medicine of the Second Affiliated Hospital of Anhui Medical University from January 2016 to February 2022 were analyzed retrospectively.Inclusion criteria:Diagnosis of HTG-SAP,age between 18 and 70 years,and admission within 48 hours of onset of symptoms.Exclusion criteria:Concurrent presence of extrapancreatic infection,malignancy or immunosuppression at the time of admission,and pregnancy or lactation.Patients were divided into three groups according to the time of preventive use of antibiotics:early prevention group（used within 72 hours after admission,n=39）,delayed prevention group（used after 72 hours,n=30）and unprevention group（n=23）.Record and analyze the general data,laboratory indicators at admission,organ function,severity score,treatment intervention,pancreatic/peripancreatic,extrapancreatic infection,distribution characteristics of pathogenic bacteria,and other clinical data of the three groups of patients.Results According to the above criteria,92 patients with HTG-SAP were finally included,including 65 males and 27 females,aged（40.8±10.55）years old.There was no statistically significant difference in baseline indicators such as sex ratio,age distribution,basic disease,laboratory indicators at admission,severity score and early treatment intervention among the groups（all P>0.05）.Among 92 patients with HTG-SAP,19 patients had pancreatic/peripancreatic infection,with an incidence of20.7%（19/92）.Compared with the patients in the non prevention group,the incidence rate of pancreatic/peripancreatic infection[10.0%（3/30）vs 39.1%（9/23）]and the incidence rate of bloodstream infection[6.7%（2/30）vs 34.8%（8/23）]in the delayed prevention group decreased,with statistically significant differences(χ2_{Pancreas/peripancreatic infection}=6.307,P=0.012;χ2_{bloodstream infection}=6.723,P=0.010).There was no significant difference in the incidence of pancreatic/peripancreatic infection and blood flow infection between the early prevention group and the delayed prevention group,and between the early prevention group and the non-prevention group（all P>0.05）.There was no statistically significant difference in the incidence of extrapancreatic infection among patients in each group（all P>0.05）.The infection rate of multiple/pan resistant bacteria in the early prevention group[23.1%（9/39）]was significantly higher than that in the unprevented group[4.3%（1/23）],the difference is statistically significant（χ2=4.495,P=0.034）.There was no significant difference in the incidence of multiple/pan-resistant bacterial infection between the early prevention group and the delayed prevention group,and between the delayed prevention group and the non-prevention group（all P>0.05）.There was no significant difference in all cause mortality,length of stay,duration of intensive care unit,hospitalization cost,incidence of intestinal fistula and retroperitoneal hemorrhage,and the proportion of patients requiring surgery among the groups（P>0.05）.Conclusion Compared with non-protective use of antibiotics,prophylactic use of antibiotics after 72 hours of admission reduced the incidence of pancreatic/peripancreatic infection and blood flow infection in HTG-SAP patients,while the incidence of pancreatic/peripancreatic infection and blood flow infection after prophylactic use of antibiotics within 72 hours of admission was not statistically significant.There was no statistically significant difference in the incidence of extrapancreatic infection,all-cause mortality,incidence of intestinal fistula and retroperitoneal hemorrhage,length of stay,length of stay in ICU and hospitalization cost of patients with HTG-SAP treated with antibiotics at different times.In addition,compared with non-protective use of antibiotics,the risk of multiple/pan-resistant bacterial infection in patients with prophylactic use of antibiotics within 72 hours of admission increased.