Effectiveness of intensive insulin therapy in the management of acute necrotizing pancreatitis induced by very severe hypertriglyceridemia

Hypertriglyceridemia may be responsible for up to 4% of acute pancreatitis. Complicated pancreatitis is a serious medical condition and might be fatal. Therefore, treating the underlying cause along with supportive measures is crucial to prevent further deterioration and possible death. There have been reports where Insulin has been the mainstay of treatment for reducing triglyceride levels in patients with pancreatitis, however, there are no well-established guidelines. We present a forty-year-old female patient diagnosed with acute necrotizing pancreatitis. CT abdomen revealed acute necrotic pancreatitis [Balthazar E] with extensive peri-pancreatic and peritoneal fluid collections. The patient was managed in the ICU for 28 days. She continued to receive gemfibrozil and insulin infusion, initiated according to the ICU's Protocol - Algorithm 1 targeting glucose values of 4.4 mmol/L to 10 mmol/L along with heparin infusion. She was successfully treated and recovered. She was discharged on antidiabetic and lipid lowering medications

[Evolution of antibiotic consumption in an intensive care burn department]

Background: The increasing consumption of antibiotics in hospitals and the economic implications of this increase lead to survey this consumption in the various hospital units

Aim: Our study proposes to measure the annual antibiotic use and antimicrobial resistance in an intensive care Burn department in order to manage the control measure

Methods: The study was conducted during a 5 year period [1 January 2000 to 31 December 2004]. The average number of admissions was 204/ year and the mean number of hospitalization was 4036/year. Antimicrobial susceptibility testing was performed by disk diffusion method. Susceptibility testing data were stored in a laboratory data base using whonet 5.3 software. The consumption of following antibiotics: imipenem, ceftazidime, ofloxacin, ciprofloxacin, piperacillin-tazobactam was measured by antimicrobial density [AD] which takes into account the quantity of antibiotics in Grams converted to daily defined dose [DDD] and number of hospitalization days. The daily defined dose [DDD] was proposed by WHO. The calculation of the AD for each molecule was carried out according to the following formula: AD=Quantity consumed in grams for the particular antimicrobial X 1000/ DDD for that antimicrobial X number of days hospitalizations

Results: There was statistically significant relationship between increasing use of ceftazidime and ceftazidime resistant Klebsiella pneumoniae [rs = 0.93; p=0.02] The use of ceftazidime was not significantly associated with resistance to this molecule in P.aeruginosa [rs=0.76; p=0.13]. Concerning the fluoroquinolones, there was statistically significant relation ship between increasing use of ciprofloxacin and rate ciprofloxacin resistant P.aeruginosa [rs = =0.89, P=0.043]. Furthermore, the consumption of ciprofloxacin was significantly correlated to imipenem resistance in P.aeruginosa [rs = 0.87, p=0.05]. However, the consumption of imipenem was not significantly correlated to resistance of this drug in P.aeruginosa [rs==0.54; P=0.4]

Conclusion: The monitoring of both antibiotic consumption andantibiotic resistance is necessary to set up targeted policies and to control their effectiveness. Nevertheless this monitoring must be integrated into global policy of good use and control of antibiotics