Fine-needle aspiration in infected necrotizing pancreatitis in the delayed intervention era: a post hoc analysis of safety, microbiological yield and therapeutic implications
Year: 2025
Type: article
Abstract: OBJECTIVES: Infected necrotizing pancreatitis is preferably managed by postponing invasive interventions and, in selected cases, treatment with antibiotics alone. Consequently, microbial cultures are often lacking, possibly increasing the risk of antibiotic treatment failure and unnecessary use of broad-spectrum antibiotics. The main objective was to describe the culture results of fine-needle aspirations (FNA) in a retrospective cohort of necrotizing pancreatitis patients, and relate this to the administered empirical antibiotic regimen to explore FNA's potential clinical value. METHODS: Post hoc analysis of a cohort of 618 patients hospitalized with acute necrotizing pancreatitis in 17 Dutch hospitals (2010-2020). RESULTS: Of 618 acute necrotizing pancreatitis patients, 68 (11%) underwent 71 FNA procedures: 11 (15%) endoscopic and 60 (85%) percutaneous. Three patients underwent repeated FNA procedures. Most FNA samples (75%) were culture-positive, all endoscopic FNA were polymicrobial (versus 27% in percutaneous FNA) and therefore suspect for contamination. Among 22 patients who received antimicrobial therapy before percutaneous FNA, 4 (18%) grew pathogens not susceptible to the administered antibiotics. Resistance in positive samples to common Dutch empirical regimens was 28% for cephalosporin/metronidazole, 19% for piperacillin-tazobactam and 21% for meropenem. No periprocedural complications occurred. CONCLUSIONS: This study suggests that diagnostic percutaneous FNA is a safe procedure with no observed complications, that may be useful in guiding antimicrobial therapy in patients with infected necrotizing pancreatitis, especially when delaying or omitting drainage procedures. Prospective studies and clinical trials are needed to confirm this. Percutaneous FNA is preferred over endoscopic FNA, as the latter carries a high risk of sample contamination.
DOI: 10.1093/jac/dkaf455
Authors: Hannah S Pauw, Astrid Beij, Hester C Timmerhuis, Lotte Boxhoorn, Marc G Besselink, Marja A Boermeester, Marco J Bruno, Adriaan C I T L Tan, Peter van Duiijvendijk, Tessa Romkens, Muhammed Hadithi, Thijs P Schwartz, Niels G Venneman, Jeroen M Jansen, Martijn W J Stommel, Rutger Quispel, Ben J Witteman, Wouter L Curvers, Tom C Seerden, Wouter L Hazen, Stefan A W Bouwense, Marcel B W Spanier, Jan W Haveman, Thomas L Bollen, Robert Verdonk, Elske Sieswerda, Rogier P Voermans, Hjalmar C Van Santvoort, Fons F Van Den Berg
Institutions: St. Antonius Ziekenhuis, Amsterdam UMC Location University of Amsterdam, Amsterdam University Medical Centers, Amsterdam Gastroenterology Endocrinology Metabolism, Erasmus MC, Canisius-Wilhelmina Ziekenhuis, Gelre Hospitals, Jeroen Bosch Ziekenhuis, Maasstad Ziekenhuis, Meander Medisch Centrum, Medisch Spectrum Twente, OLVG, Radboud University Medical Center, Reinier de Graaf Hospital, Ziekenhuis Gelderse Vallei, Catharina Ziekenhuis, Amphia Ziekenhuis, Elisabeth-TweeSteden Ziekenhuis, Maastricht University Medical Centre, Maastricht University, Rijnstate Hospital, University Medical Center Groningen, University of Groningen, Utrecht University, University Medical Center Utrecht, Ecraid Foundation (Netherlands), Amsterdam institute for Immunology and Infectious Diseases
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4417427292