Mazaki T, Ishii Y, Takayama T
Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
Br J Surg. 2006 Jun;93(6):674-84. doi: 10.1002/bjs.5389.
Death from infected necrosis in acute pancreatitis is common and prevention has focused on prophylactic antibiotics. This study assesses whether intravenous prophylactic antibiotic use reduces infected necrosis and death in acute necrotizing pancreatitis.
A meta-analysis of randomized controlled trials was carried out. Medline, Web of Science, the Cochrane controlled trials register and international conference proceedings were searched, with a citation review of relevant primary and review articles.
Six of 328 studies assessed were included in data extraction. Primary outcome measures were infected necrosis and death. Secondary outcome measures were non-pancreatic infections, surgical intervention and length of hospital stay. Prophylactic antibiotic use was not associated with a statistically significant reduction in infected necrosis (relative risk (RR) 0.77 (95 per cent confidence interval (c.i.) 0.54 to 1.12); P = 0.173), mortality (RR 0.78 (95 per cent c.i. 0.44 to 1.39); P = 0.404), non-pancreatic infections (RR 0.71 (95 per cent c.i. 0.32 to 1.58); P = 0.402) and surgical intervention (RR 0.78 (95 per cent c.i. 0.55 to 1.11); P = 0.167). It was, however, associated with a statistically significant reduction in hospital stay (P = 0.040).
Prophylactic antibiotics do not prevent infected necrosis or death in acute necrotizing pancreatitis.
急性胰腺炎感染性坏死导致的死亡很常见，预防措施主要集中在预防性使用抗生素。本研究评估静脉预防性使用抗生素是否能减少急性坏死性胰腺炎的感染性坏死和死亡。
进行了一项随机对照试验的荟萃分析。检索了Medline、科学网、Cochrane对照试验注册库和国际会议论文集，并对相关的原始文章和综述文章进行了引文回顾。
纳入数据提取的328项研究中有6项。主要结局指标为感染性坏死和死亡。次要结局指标为非胰腺感染、手术干预和住院时间。预防性使用抗生素与感染性坏死（相对危险度（RR）0.77（95%置信区间（c.i.）0.54至1.12）；P = 0.173）、死亡率（RR 0.78（95% c.i. 0.44至1.39）；P = 0.404）、非胰腺感染（RR 0.71（95% c.i. 0.32至1.58）；P = 0.402）和手术干预（RR 0.78（95% c.i. 0.55至1.11）；P = 0.167）的统计学显著降低无关。然而，它与住院时间的统计学显著缩短有关（P = 0.040）。
预防性使用抗生素不能预防急性坏死性胰腺炎的感染性坏死或死亡。
