Andrea Párniczky1, Tamás Lantos2, Eszter Margit Tóth3, Zsolt Szakács4, Szilárd Gódi5, Roland Hágendorn6, Dóra Illés7, Balázs Koncz7, Katalin Márta4, Alexandra Mikó8, Dóra Mosztbacher9, Balázs Csaba Németh10, Dániel Pécsi4, Anikó Szabó4, Ákos Szücs11, Péter Varjú4, Andrea Szentesi12, Erika Darvasi7, Bálint Erőss4, Ferenc Izbéki13, László Gajdán13, Adrienn Halász13, Áron Vincze5, Imre Szabó5, Gabriella Pár5, Judit Bajor5, Patrícia Sarlós5, József Czimmer5, József Hamvas14, Tamás Takács7, Zoltán Szepes7, László Czakó7, Márta Varga15, János Novák16, Barnabás Bod17, Attila Szepes18, János Sümegi19, Mária Papp20, Csaba Góg21, Imola Török22, Wei Huang23, Qing Xia23, Ping Xue24, Weiqin Li25, Weiwei Chen26, Natalia V Shirinskaya27, Vladimir L Poluektov28, Anna V Shirinskaya28, Péter Jenő Hegyi29, Marian Bátovský30, Juan Armando Rodriguez-Oballe31, Isabel Miguel Salas31, Javier Lopez-Diaz32, J Enrique Dominguez-Munoz32, Xavier Molero33, Elizabeth Pando34, María Lourdes Ruiz-Rebollo35, Beatriz Burgueño-Gómez35, Yu-Ting Chang36, Ming-Chu Chang36, Ajay Sud37, Danielle Moore37, Robert Sutton37, Amir Gougol38, Georgios I Papachristou38, Yaroslav Mykhailovych Susak39, Illia Olehovych Tiuliukin39, António Pedro Gomes40, Maria Jesus Oliveira40, David João Aparício40, Marcel Tantau41, Floreta Kurti42, Mila Kovacheva-Slavova43, Stephanie-Susanne Stecher44, Julia Mayerle44, Goran Poropat45, Kshaunish Das46, Marco Vito Marino47, Gabriele Capurso48, Ewa Małecka-Panas49, Hubert Zatorski49, Anita Gasiorowska50, Natalia Fabisiak50, Piotr Ceranowicz51, Beata Kuśnierz-Cabala51, Joana Rita Carvalho52, Samuel Raimundo Fernandes52, Jae Hyuck Chang53, Eun Kwang Choi54, Jimin Han55, Sara Bertilsson56, Hanaz Jumaa57, Gabriel Sandblom58, Sabite Kacar59, Minas Baltatzis60, Aliaksandr Vladimir Varabei61, Vizhynis Yeshy62, Serge Chooklin63, Andriy Kozachenko64, Nikolay Veligotsky65, Péter Hegyi66. 1. Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; Heim Pál National Insititute of Pediatrics, Budapest, Hungary. 2. Department of Medical Physics and Informatics, Faculty of Medicine, University of Szeged, Szeged, Hungary. 3. Pándy Kálmán Hospital of Békés County, Gyula, Hungary; First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary. 4. Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary. 5. Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary. 6. Intesive Care Unit, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary. 7. First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary. 8. Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; Division of Translational Medicine, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary. 9. Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; First Department of Pediatrics, Semmelweis University, Budapest, Hungary. 10. First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary; Hungarian Academy of Sciences-University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary. 11. First Department of Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary. 12. Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary. 13. Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary. 14. Bajcsy-Zsilinszky Hospital, Budapest, Hungary. 15. Dr. Réthy Pál Hospital, Békéscsaba, Hungary. 16. Pándy Kálmán Hospital of Békés County, Gyula, Hungary. 17. Dr. Bugyi István Hospital, Szentes, Hungary. 18. Bács-Kiskun County Hospital, Kecskemét, Hungary. 19. Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, Miskolc, Hungary. 20. Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Debrecen, Hungary. 21. Healthcare Center of County Csongrád, Makó, Hungary. 22. County Emergency Clinical Hospital of Targu Mures Hospital, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Targu Mures, Romania. 23. Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital of Sichuan University, Chengdu, China. 24. Department of Integrated Traditional Chinese and Western Medicine, Shangjin Hospital, West China Medical School of Sichuan University, Chengdu, China. 25. Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. 26. Department of Gastroenterology, Subei People's Hospital of Jiangsu Province, Clinical Medical College of Yangzhou University, Yangzhou, China. 27. Omsk State Medical Information-Analytical Centre, Omsk State Clinical Emergency Hospital #2, Omsk, Russia. 28. Department of Surgery and Urology, Omsk State Medical University, Omsk, Russia. 29. Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; Departement of Gastroenterology Slovak Medical University in Bratislava, Bratislava, Slovakia. 30. Departement of Gastroenterology Slovak Medical University in Bratislava, Bratislava, Slovakia. 31. Department of Gastroenterology, University Hospital Santa María - University Hospital Arnau de Vilanova, Lerida, Spain. 32. Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain. 33. Exocrine Pancreas Research Unit, Hospital Universitari Vall d'Hebron - Institut de Recerca, Autonomous University of Barcelona, CIBEREHD, Barcelona, Spain. 34. Department of Hepato-pancreato-biliary and Transplat Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 35. Digestive Diseases Department Clinical University Hospital of Valladolid, Valladolid, Spain. 36. Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. 37. Liverpool Pancreatitis Research Group, University of Liverpool and the Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, United Kingdom. 38. Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 39. O.O.Bogomolets National Medical University, Kiev, Ukraine. 40. Department of Surgery, Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal. 41. Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Internal Medicine, 3rd Medical Clinic and "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. 42. Department of Gastroenterology and Hepatology, University Hospital Center "Mother Theresa", Tirana, Albania. 43. University Hospital "Tsaritsa Ioanna - ISUL", Departement of Gastroenterology, Sofia, Bulgaria. 44. Department of Medicine II, University Hospital, LMU Munich, Germany. 45. Department of Gastroenterology, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Croatia. 46. Division of Gastroenterology, School of Digestive and Liver Diseases, IPGME &R, Kolkata, India. 47. Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy. 48. PancreatoBiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy. 49. Department of Digestive Tract Diseases, Medical University of Lodz, Poland. 50. Department of Gastroenterology Medical University of Lodz, Poland. 51. Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland. 52. Department of Gastroenterology and Hepatology, North Lisbon Hospital Center, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal. 53. Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 54. Department of Internal Medicine, Jeju National University College of Medicine, Jeju, South Korea. 55. Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, South Korea. 56. Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Health Sciences, Lund University, Lund, Sweden. 57. Eskilstuna Hospital, Mälarsjukhuset, Eskilstuna, Sweden. 58. Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Department of Surgery, Södersjukhuset, Stockholm, Sweden. 59. Department of Gastroenterology Türkiye Yüksek İhtisas Hospital, Ankara, Turkey. 60. Manchester Royal Infirmary Hospital, Manchester, United Kingdom. 61. Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus. 62. Department of Surgery, Belarusian Medical Academy Postgraduate Education, Minsk, Belarus. 63. Regional Clinical Hospital, Lviv, Ukraine. 64. Kharkiv Emergency Hospital, Medical Faculty of V. N. Karazin Kharkiv National University, Kharkiv, Ukraine. 65. Department Thoraco-abdominal Surgery Kharkov Medical Academy Postgraduate Education, Kharkov, Ukraine. 66. Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary; Division of Translational Medicine, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary; Hungarian Academy of Sciences-University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary. Electronic address: hegyi.peter@pte.hu.
Abstract
BACKGROUND: Unwarranted administration of antibiotics in acute pancreatitis presents a global challenge. The clinical reasoning behind the misuse is poorly understood. Our aim was to investigate current clinical practices and develop recommendations that guide clinicians in prescribing antibiotic treatment in acute pancreatitis. METHODS: Four methods were used. 1) Systematic data collection was performed to summarize current evidence; 2) a retrospective questionnaire was developed to understand the current global clinical practice; 3) five years of prospectively collected data were analysed to identify the clinical parameters used by medical teams in the decision making process, and finally; 4) the UpToDate Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was applied to provide evidence based recommendations for healthcare professionals. RESULTS: The systematic literature search revealed no consensus on the start of AB therapy in patients with no bacterial culture test. Retrospective data collection on 9728 patients from 22 countries indicated a wide range (31-82%) of antibiotic use frequency in AP. Analysis of 56 variables from 962 patients showed that clinicians initiate antibiotic therapy based on increased WBC and/or elevated CRP, lipase and amylase levels. The above mentioned four laboratory parameters showed no association with infection in the early phase of acute pancreatitis. Instead, procalcitonin levels proved to be a better biomarker of early infection. Patients with suspected infection because of fever had no benefit from antibiotic therapy. CONCLUSIONS: The authors formulated four consensus statements to urge reduction of unjustified antibiotic treatment in acute pancreatitis and to use procalcitonin rather than WBC or CRP as biomarkers to guide decision-making.
BACKGROUND: Unwarranted administration of antibiotics in acute pancreatitis presents a global challenge. The clinical reasoning behind the misuse is poorly understood. Our aim was to investigate current clinical practices and develop recommendations that guide clinicians in prescribing antibiotic treatment in acute pancreatitis. METHODS: Four methods were used. 1) Systematic data collection was performed to summarize current evidence; 2) a retrospective questionnaire was developed to understand the current global clinical practice; 3) five years of prospectively collected data were analysed to identify the clinical parameters used by medical teams in the decision making process, and finally; 4) the UpToDate Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was applied to provide evidence based recommendations for healthcare professionals. RESULTS: The systematic literature search revealed no consensus on the start of AB therapy in patients with no bacterial culture test. Retrospective data collection on 9728 patients from 22 countries indicated a wide range (31-82%) of antibiotic use frequency in AP. Analysis of 56 variables from 962 patients showed that clinicians initiate antibiotic therapy based on increased WBC and/or elevated CRP, lipase and amylase levels. The above mentioned four laboratory parameters showed no association with infection in the early phase of acute pancreatitis. Instead, procalcitonin levels proved to be a better biomarker of early infection. Patients with suspected infection because of fever had no benefit from antibiotic therapy. CONCLUSIONS: The authors formulated four consensus statements to urge reduction of unjustified antibiotic treatment in acute pancreatitis and to use procalcitonin rather than WBC or CRP as biomarkers to guide decision-making.
Authors: Máté Nagy-Pénzes; Zoltán Hajnády; Zsolt Regdon; Máté Á Demény; Katalin Kovács; Tarek El-Hamoly; József Maléth; Péter Hegyi; Csaba Hegedűs; László Virág Journal: Biomedicines Date: 2022-06-10
Authors: Balázs Kui; József Pintér; Roland Molontay; Marcell Nagy; Nelli Farkas; Noémi Gede; Áron Vincze; Judit Bajor; Szilárd Gódi; József Czimmer; Imre Szabó; Anita Illés; Patrícia Sarlós; Roland Hágendorn; Gabriella Pár; Mária Papp; Zsuzsanna Vitális; György Kovács; Eszter Fehér; Ildikó Földi; Ferenc Izbéki; László Gajdán; Roland Fejes; Balázs Csaba Németh; Imola Török; Hunor Farkas; Artautas Mickevicius; Ville Sallinen; Shamil Galeev; Elena Ramírez-Maldonado; Andrea Párniczky; Bálint Erőss; Péter Jenő Hegyi; Katalin Márta; Szilárd Váncsa; Robert Sutton; Peter Szatmary; Diane Latawiec; Chris Halloran; Enrique de-Madaria; Elizabeth Pando; Piero Alberti; Maria José Gómez-Jurado; Alina Tantau; Andrea Szentesi; Péter Hegyi Journal: Clin Transl Med Date: 2022-06
Authors: Pedro Silva-Vaz; Ana Margarida Abrantes; Miguel Castelo-Branco; António Gouveia; Maria Filomena Botelho; José Guilherme Tralhão Journal: Int J Mol Sci Date: 2020-01-04 Impact factor: 5.923
Authors: Klementina Ocskay; Zsófia Vinkó; Dávid Németh; László Szabó; Judit Bajor; Szilárd Gódi; Patrícia Sarlós; László Czakó; Ferenc Izbéki; József Hamvas; Mária Papp; Márta Varga; Imola Török; Artautas Mickevicius; Ville Sallinen; Elena Ramirez Maldonado; Shamil Galeev; Alexandra Mikó; Bálint Erőss; Marcell Imrei; Péter Jenő Hegyi; Nándor Faluhelyi; Orsolya Farkas; Péter Kanizsai; Attila Miseta; Tamás Nagy; Roland Hágendorn; Zsolt Márton; Zsolt Szakács; Andrea Szentesi; Péter Hegyi; Andrea Párniczky Journal: Sci Rep Date: 2021-12-17 Impact factor: 4.379