Demonstrating infection in severe acute pancreatitis: A role for polymerase chain reaction and gene sequencing?

摘要

Sepsis in acute pancreatitis (AP) carries a high mortality rate and accounts for approximately 80% of all deaths from this disease (1). In severe AP with extensive necrosis, the infection rate may be as high as 55% to 70% (2). The mechanism of such infection has been the subject of considerable investigation. Animal studies have implicated bacterial trans-location from the gastrointestinal tract (3). In humans, however, definitive evidence for such intestinal barrier dysfunction is lacking (4,5), although the predominance of Gram-negative aerobic species in cultured samples and the presence of circulating endotoxin lend credence to this hypothesis. Based on this, there have been a host of studies investigating the ability of probiotics, antibiotics, and selective decontamination of the digestive tract to reduce the prevalence of pancreatic superin-fection (3,6).