Xu Tao, Cai Qingping
Department of General Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Scand J Gastroenterol. 2008;43(10):1249-58. doi: 10.1080/00365520802130175.
The effect of prophylactic antibiotic treatment on infection and survival of acute necrotizing pancreatitis (ANP) remains uncertain. The aim of this study was to assess the long-term efficacy of prophylactic antibiotic treatment for ANP.
Searches were carried out of electronic databases including Medline, EMBASE, the Cochrane Controlled Trials Register, the Science Citation Index, and PubMed (updated to December 2007), and manual bibliographical searches were also conducted. A meta-analysis of all randomized controlled trials (RCTs) comparing prophylactic antibiotic treatment with placebo or no treatment was performed.
Eight RCTs including 540 patients were assessed. The outcomes included infected necrosis, death, non-pancreatic infection, surgical intervention, and length of hospital stay. Prophylactic antibiotic use leads to a significant reduction of infected necrosis (relative risk (RR) 0.69, 95% CI, 0.50-0.95; p=0.02), non-pancreatic infections (RR 0.66 95% CI, 0.48-0.91; p=0.01), and length of hospital stay (p=0.004) but was not associated with a statistically significant reduction in mortality (RR 0.76 95% CI, 0.50-1.18; p=0.22) and surgical intervention (RR 0.90 95% CI, 0.66-1.23; p=0.52). In a subgroup analysis, carbapenem was associated with a significant reduction in infected necrosis (p=0.009) and non-pancreatic infections (p=0.006), whereas other antibiotics were not.
Prophylactic antibiotic treatment is associated with a significant reduction of pancreatic or peripancreatic infection, non-pancreatic infection, and length of hospital stay, but cannot prevent death and surgical intervention in acute necrotizing pancreatitis.
预防性抗生素治疗对急性坏死性胰腺炎（ANP）感染及存活情况的影响仍不明确。本研究旨在评估ANP预防性抗生素治疗的长期疗效。
检索了包括Medline、EMBASE、Cochrane对照试验注册库、科学引文索引和PubMed（更新至2007年12月）在内的电子数据库，并进行了手工文献检索。对所有比较预防性抗生素治疗与安慰剂或不治疗的随机对照试验（RCT）进行了荟萃分析。
评估了8项RCT，共540例患者。结果包括感染性坏死、死亡、非胰腺感染、手术干预和住院时间。预防性使用抗生素可显著降低感染性坏死（相对危险度（RR）0.69，95%可信区间（CI），0.50 - 0.95；p = 0.02）、非胰腺感染（RR 0.66，95% CI，0.48 - 0.91；p = 0.01）和住院时间（p = 0.004），但与死亡率的显著降低（RR 0.76，95% CI，0.50 - 1.18；p = 0.22）和手术干预（RR 0.90，95% CI，0.66 - 1.23；p = 0.52）无关。在亚组分析中，碳青霉烯类药物与感染性坏死（p = 0.009）和非胰腺感染（p = 0.006）的显著降低相关，而其他抗生素则无此关联。
预防性抗生素治疗与胰腺或胰周感染、非胰腺感染及住院时间的显著降低相关，但不能预防急性坏死性胰腺炎的死亡和手术干预。
