Abstract
Severe pancreatitis is almost always characterized by the presence of glandular necrosis, which determines a clear worsening in the prognosis of the patients in terms of either complications or mortality. Necrotic infection is the single factor able to triple mortality in severe pancreatitis and is strictly correlated with the amount of necrosis. In this regard it is of great importance to identify patients affected by pancreatic necrosis as soon as possible in order to make every effort to prevent necrotic infection. Determination of C-reactive protein in serum and a contrast-enhanced CT scan 48–72 h after the onset of symptoms are two easily performed procedures for the detection of necrosis. Total enteral nutrition and early antibiotic treatment are the only therapeutic options to prevent necrotic infection but some authors have expressed concerns about antibiotic prophylaxis because of the role of antibiotics in the selection of multiresistant pathogens and fungi. However, it is recommended nowadays that patients affected by well-documented pancreatic necrosis involving >30% of the parenchyma should be treated early with i.v. imipenem–cilastatin at a dosage of 500 mg t.i.d.