This is the podcast, ICU rounds.

My name is Dr. Jeffrey Guy.

I'm an associate professor of surgery and director at the Burns Center at the Vanderbilt University School of Medicine in Nashville, Tennessee.

Back to the podcast, ICU rounds.

We've been talking recently about pancreatitis, severe acute necrotizing pancreatitis,

and the previous episodes have talked about how do we make the diagnosis of pancreatitis

and what causes it, what patient populations are predisposed.

The second podcast focused a little bit more on some of the physiological support,

fluid, or cessation, and nutrition.

In this episode, I want to start out by looking at the issues of infection.

Should we start the patient on antibiotics, antibiotic prophylaxis, when and how do we make

the diagnosis of either pancreatic necrosis or infection of the pancreas.

Since depending on some series, infections of the pancreas or of the necrotic pancreas are

responsible for 80% of the deaths, it's not an unreasonable consideration to ask oneself would the administration of antibiotics of this

patient perhaps bend that curve perhaps improve survival or reduce the morbidity and mortality

groups of patients that are a high risk for development of infection are those who have

more than 30 percent of the gland that's necrotic. Now this is evident on cat scanning.

We haven't really gone into this much and we plan on going to this a little bit later.

But if the patient has more than 30% necrosis, pancreatic infection is seen in about 30% to 40% of these patients.

How the pancreas gets infected is theorized that its bacterial translocation from the

colon being the most likely cause.

Other sources that can infect the pancreas, some feel is through either direct spread

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