Necrotic pancreatitis: modern approaches to the prevention of infected necrosis

TL;DR

This review discusses modern strategies for preventing infected necrosis in necrotizing pancreatitis, highlighting the role of nutrition and the ongoing debate around antibiotic use.

Contribution

The paper provides an updated synthesis of prevention strategies for infected necrosis in necrotizing pancreatitis, emphasizing recent advances in risk stratification.

Findings

Early enteral nutrition is supported as a protective measure against infected necrosis.

Antibiotic prophylaxis remains controversial due to inconsistent clinical trial results.

Machine learning models show promise in predicting infection risk for personalized prevention.

Abstract

The investigation of etiological factors in acute pancreatitis is a critical task, as their elucidation contributes to advancing both the diagnosis and prevention of the disease. Necrotizing pancreatitis (NP) is a severe complication of acute pancreatitis associated with high morbidity and mortality due to enzymatic tissue destruction, systemic inflammation, and the risk of infected necrosis. This review synthesizes current knowledge on the pathogenesis, classification, and epidemiology of NP, with emphasis on strategies aimed at preventing infectious complications. Evidence consistently supports the protective role of early enteral nutrition, while the use of selective digestive decontamination and antibiotic prophylaxis remains debated. Although several clinical trials and meta-analyses have explored antibiotic prophylaxis, results are inconclusive, reflecting heterogeneity in study design, antibiotic regimens, and patient selection. Recent advances in risk stratification, including the application of machine learning models, offer promising tools for identifying patients at highest risk for infection and tailoring preventive interventions. Nevertheless, important knowledge gaps remain, particularly regarding the optimal timing, duration, and selection of prophylactic measures. Current data suggest that prevention strategies should integrate nutritional support, judicious antimicrobial use, and individualized risk prediction. In conclusion, while significant progress has been made in understanding NP and developing preventive approaches, the efficacy of antibiotic prophylaxis continues to be controversial. Future large-scale, methodologically rigorous studies are needed to establish standardized preventive protocols and ultimately improve clinical outcomes in patients with necrotizing pancreatitis.

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