De Waele Jan J
Department of Critical Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
Crit Care. 2008;12(6):195. doi: 10.1186/cc7122. Epub 2008 Dec 2.
The use of prophylactic antibiotics in patients with severe acute pancreatitis remains an intensely debated topic. Although animal studies consistently demonstrated an advantage of antibiotic prophylaxis, the only two blinded randomized controlled trials could not confirm these findings. Translation of the experimental models in human clinical practice is hampered by a number of fundamental differences between experimental pancreatitis and human disease, and therefore it is highly unlikely that the pronounced benefit found in experimental pancreatitis will ever be demonstrated in human disease. Early and accurate risk stratification to identify the patient at risk for infection early in the course of the disease seems to be the greatest challenge. Until we are able to demonstrate an advantage of antibiotic prophylaxis in a high-risk human population, the absence of proven benefit and potential side effects of this strategy should be acknowledged and the use of antibiotics should be limited to the treatment of documented infection.
在重症急性胰腺炎患者中使用预防性抗生素仍然是一个备受争议的话题。尽管动物研究一直表明抗生素预防有优势，但仅有的两项双盲随机对照试验未能证实这些结果。实验性胰腺炎与人类疾病之间存在一些根本差异，这阻碍了将实验模型转化为人类临床实践，因此，在实验性胰腺炎中发现的显著益处极不可能在人类疾病中得到证实。在疾病过程早期进行早期准确的风险分层以识别有感染风险的患者似乎是最大的挑战。在我们能够证明抗生素预防对高危人群有优势之前，应认识到该策略缺乏已证实的益处和潜在副作用，抗生素的使用应仅限于治疗已记录的感染。
