Wittau Mathias, Mayer Benjamin, Scheele Jan, Henne-Bruns Doris, Dellinger E Patchen, Isenmann Rainer
Department of General, Visceral and Transplantation Surgery, University Hospital Ulm, Steinhoevelstrasse 9, Ulm, Germany.
Scand J Gastroenterol. 2011 Mar;46(3):261-70. doi: 10.3109/00365521.2010.531486. Epub 2010 Nov 10.
The incidence of acute pancreatitis varies from 5 to 80 per 100,000 throughout the world. The most common cause of death in these patients is infection of pancreatic necrosis by enteric bacteria, spurring the discussion of whether or not prophylactic antibiotic administration could be a beneficial approach. In order to provide evidence of the effect of antibiotic prophylaxis in severe acute pancreatitis (SAP) we performed an updated systematic review and meta-analysis on this topic.
The review of randomized controlled trials was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We conducted a search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. For assessment of the treatment effects we calculated the risk ratios (RRs) for dichotomous data of included studies.
Fourteen trials were included with a total of 841 patients. The use of antibiotic prophylaxis was not associated with a statistically significant reduction in mortality (RR 0.74 [95% CI 0.50-1.07]), in the incidence of infected pancreatic necrosis (RR 0.78 [95% CI 0.60-1.02]), in the incidence of non-pancreatic infections (RR 0.70 [95% CI 0.46-1.06]), and in surgical interventions (RR 0.93 [95% CI 0.72-1.20]).
In summary, to date there is no evidence that supports the routine use of antibiotic prophylaxis in patients with SAP.
全球急性胰腺炎的发病率为每10万人中有5至80例。这些患者最常见的死亡原因是肠道细菌感染胰腺坏死，这引发了关于预防性使用抗生素是否有益的讨论。为了提供抗生素预防在重症急性胰腺炎（SAP）中效果的证据，我们对该主题进行了最新的系统评价和荟萃分析。
按照系统评价和荟萃分析的首选报告项目（PRISMA）声明对随机对照试验进行评价。我们检索了MEDLINE、EMBASE和Cochrane对照试验中央注册库。为了评估治疗效果，我们计算了纳入研究的二分数据的风险比（RRs）。
纳入14项试验，共841例患者。预防性使用抗生素与死亡率的统计学显著降低（RR 0.74 [95%CI 0.50 - 1.07]）、感染性胰腺坏死的发生率（RR 0.78 [95%CI 0.60 - 1.02]）、非胰腺感染的发生率（RR 0.70 [95%CI 0.46 - 1.06]）以及手术干预（RR 0.93 [95%CI 0.72 - 1.20]）均无关联。
总之，迄今为止，没有证据支持在SAP患者中常规使用抗生素预防。
