Although the factors that trigger bacterial infection of necrosis have not been properly identified yet, it is most likely that the extent of necrotic parenchyma is a major determinant.¹⁰

The main pathogenetic factor of infected pancreatic necrosis is translocation of enteric bacteria from the intestine into the necrotic region. As a consequence, Gram-negative bacteria are predominantly found in infected necrosis.^7,11,12 However, the spectrum of bacteria identified in infected necrosis has changed over the past years; today, Gram-positive bacteria as well as fungi play a significant role.

Given the severe prognosis of infected pancreatic necrosis, it is evident that a promising approach to improving the outcome could be the prevention of acterial infection by systemic prophylactic antibiotics. Theoretically, this should be initiated as early as possible and continued for a longer period of time, as infected necroses are commonly observed during the second to fourth week after onset of pancreatitis. It is generally accepted that prophylactic antibiotic administration will play a potential beneficial role only in the presence of pancreatic necrosis. As long as there is no clinical evidence of necrotising pancreatitis, antibiotics should only be applied to patients with a clearly proven, nonpancreatic bacterial infection, such as pneumonia or urinary tract infection.

This article focuses on the development in this field that has taken place during the last two to three decades. The authors give an overview over the relevant data and a short description of the major treatment guidelines.