Modification and duration of therapy for infected pancreatic fluid collection

Modify therapy for infected pancreatic collection according to the results of culture and susceptibility testing. Reserve carbapenems for infections caused by pathogens resistant to other antibiotics, because clinical data to support the superiority of empirical use of carbapenems over piperacillin+tazobactam are lacking.

The optimal duration of therapy for infected pancreatic collection is uncertain. If adequate surgical source control has been achieved, stop antibiotic therapy after 5 to 7 days and observe for clinical deteriorationWolbrink, 2020. The decision to prolong therapy should be based on careful review of the patient’s clinical status, and radiology and pathology results.

For cases that do not resolve within 7 to 10 days, consider secondary infection with Candida species or multidrug-resistant organisms such as vancomycin-resistant enterococci and multidrug-resistant Enterobacterales. Antimicrobial therapy should be directed by the results of culture and susceptibility testing of samples taken from a deep site – seek expert surgical, infectious diseases and clinical microbiology advice and consult specialist guidelines (eg Consensus guidelines for the diagnosis and management of invasive candidiasis in haematology, oncology and intensive care settings).