alongside invasive drainage interventions and supportive care. There is, however, no evidence what the best treatment strategy is regarding type, guidance, and duration of antibiotics. In daily practice, individual antibiotic treatment strategies in these patients are therefore very heterogeneous and often inappropriate
There are several explanations for the high rate of inappropriate use of antibiotics in necrotizing pancreatitis. First, patients with necrotizing pancreatitis are often misclassified as having a severe infection for which antibiotics should be started. Secondly, optimal duration of antibiotic therapy is unknown. Finally, microbiological cultures are often not obtained before antibiotics are started or empirically started antibiotics are not adjusted according to culture results. Improvement of appropriate use of antibiotics would likely lead to superior clinical outcome as well as decreases risk on antimicrobial resistance which is a growing and alarming global health threat.
Appropriate of antibiotics could be achieved by an antibiotic stewardship approach. This consists of an integrated strategy to improve the quality of antimicrobial use with the goal to improve patient outcomes, stop the rapidly growing rise in antimicrobial resistance, and reduce unnecessary costs.
The PIANO trial is a multicenter, cluster-randomized, non-inferiority trial in all Dutch hospitals collaborating within the Dutch Pancreatitis Study Group (DPSG). All hospitalized adult patients with necrotizing pancreatitis will be included. A bundle approach based on antibiotic stewardship principles will be compared with current care.
The main objective is to compare the current care with the implementation of a structured and multifaceted approach based on antibiotic stewardship principles for patients with necrotizing pancreatitis in terms of mortality, major complications, number of interventions, hospital stay, and quality of life.
