Soares-Weiser K, Brezis M, Tur-Kaspa R, Paul M, Yahav J, Leibovici L
Dept. of Medicine E, Beilinson Campus, Rabin Medical Center, Petah Tikva, Israel.
Scand J Gastroenterol. 2003 Feb;38(2):193-200. doi: 10.1080/00365520310000690.
Antibiotic prophylaxis has been reported to decrease bacterial infections and fatality rates in inpatients with cirrhosis. We performed a systematic review to evaluate the efficacy of antibiotic prophylaxis in inpatients with cirrhosis, regardless of the underlying risk factors that led to hospital admission.
A comprehensive literature search strategy was performed including the Cochrane Library, Embase, Medline, a manual search of bibliographic references, and contacting the authors of each included trial. We included any randomized clinical trial comparing different types of antibiotic prophylaxis with placebo or no intervention in inpatients with cirrhosis. Two reviewers independently applied the selection criteria to all identified references, appraised the methodological quality of each trial and extracted the relevant data. Relative risks and 95% confidence intervals were estimated using the fixed effect model. A test of heterogeneity and a funnel plot were performed and an intention-to-treat approach was used for the outcome measures.
Nineteen randomized trials were identified, 13 of which were included in the review. A significant beneficial effect on mortality (RR: 0.70; 95% CI: 0.56, 0.89) and prevention of bacterial infections (RR: 0.39; 95% CI: 0.32, 0.48) was observed, regardless of the underlying risk factors. Few adverse events were reported and there was no heterogeneity between studies. We identified a funnel plot asymmetry for the included trials.
Antibiotic prophylaxis for inpatients with cirrhosis is efficacious in reducing the number of deaths and bacterial infections regardless of the underlying risk factors.
据报道，抗生素预防可降低肝硬化住院患者的细菌感染率和死亡率。我们进行了一项系统评价，以评估抗生素预防对肝硬化住院患者的疗效，无论导致住院的潜在风险因素如何。
实施了全面的文献检索策略，包括Cochrane图书馆、Embase、Medline、对手动检索的参考文献进行检索，并联系每项纳入试验的作者。我们纳入了任何比较不同类型抗生素预防与安慰剂或无干预措施对肝硬化住院患者疗效的随机临床试验。两名评价员独立将选择标准应用于所有识别出的参考文献，评估每项试验的方法学质量并提取相关数据。使用固定效应模型估计相对风险和95%置信区间。进行了异质性检验和漏斗图分析，并对结局指标采用意向性分析方法。
共识别出19项随机试验，其中13项纳入本评价。无论潜在风险因素如何，均观察到抗生素预防对死亡率（相对风险：0.70；95%置信区间：0.56，0.89）和预防细菌感染（相对风险：0.39；95%置信区间：0.32，0.48）有显著有益效果。报告的不良事件很少，且各研究之间无异质性。我们发现纳入试验的漏斗图存在不对称性。
无论潜在风险因素如何，肝硬化住院患者使用抗生素预防可有效减少死亡人数和细菌感染。
