法国一项关于肝硬化患者抗生素预防使用的全国性调查

A French national survey on the use of antibiotic prophylaxis in cirrhotic patients.

机构信息

Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Universitaire Jean Minjoz, Besançon, France.

出版信息

Liver Int. 2013 Mar;33(3):389-97. doi: 10.1111/liv.12093. Epub 2013 Jan 10.

DOI:10.1111/liv.12093

PMID:23302021

Abstract

BACKGROUND

Guidelines recommend antibiotic prophylaxis (AP) in well-selected groups of cirrhotic patients, but the impact of these recommendations has not been assessed in France.

AIM

To evaluate AP prescription tendencies for gastrointestinal bleeding, and primary and secondary prophylaxis of spontaneous bacterial peritonitis (SBP).

METHODS

Practitioners (n = 1,159) working in general hospitals (GH) or in university hospitals (UH) received a self-administered questionnaire.

RESULTS

Three hundred and eighty-nine (33.6%; GH 35% and UH 30.4%) practitioners responded. AP was prescribed by 97.7%, 72.3% and 94.8% of practitioners, without significant differences between UH and GH, respectively, for gastrointestinal bleeding (quinolones 48.2%, third-generation cephalosporins 27.7% and amoxicillin-clavulanic acid 22.2%), primary (quinolones 97.2%) and secondary prophylaxis of SBP (quinolones 99%). For gastrointestinal bleeding, ofloxacin (47.6%) and norfloxacin (37.4%) were the main quinolones prescribed, and ceftriaxone (77%) was the main third-generation cephalosporin prescribed. The principal reasons for prescribing AP were a decrease in bacterial infection (88.9% for gastrointestinal bleeding, 91.3% for primary and 94.3% for secondary prophylaxis of SBP), a recommendation by a consensus conference (83%, 38% and 74.4% respectively) and an improvement in survival (72.8%, 41.3% and 57.7% respectively). Only 31.7% of practitioners (39.6% for UH vs. 28.6% for GH; P = 0.038) believed that AP may reduce the risk of bleeding recurrence. Reported side effects (28%) of AP mainly concerned the risk of quinolone resistance (62% of cases).

CONCLUSION

Antibiotic prophylaxis is well-recognized by French practitioners, but its routine use depends on the expertise of practitioners. Quinolones remain the main antibiotic class prescribed irrespective of the type of prophylaxis.

摘要

背景

指南建议在选择良好的肝硬化患者群体中使用抗生素预防（AP），但这些建议的影响尚未在法国得到评估。

目的

评估胃肠道出血、自发性细菌性腹膜炎（SBP）的一级和二级预防中 AP 处方的趋势。

方法

在综合医院（GH）或大学医院（UH）工作的医生（n=1159）收到了一份自我管理问卷。

结果

389 名（33.6%；UH 为 30.4%，GH 为 35%）医生做出了回应。AP 的处方率分别为 97.7%、72.3%和 94.8%，UH 和 GH 之间无显著差异，分别用于胃肠道出血（喹诺酮类 48.2%、第三代头孢菌素 27.7%和阿莫西林-克拉维酸 22.2%）、原发性（喹诺酮类 97.2%）和 SBP 的二级预防（喹诺酮类 99%）。对于胃肠道出血，氧氟沙星（47.6%）和诺氟沙星（37.4%）是主要使用的喹诺酮类药物，头孢曲松（77%）是主要使用的第三代头孢菌素。处方 AP 的主要原因是细菌感染减少（胃肠道出血为 88.9%，原发性为 91.3%，二级预防为 94.3%）、共识会议的推荐（分别为 83%、38%和 74.4%）和生存改善（分别为 72.8%、41.3%和 57.7%）。只有 31.7%的医生（UH 为 39.6%，GH 为 28.6%；P=0.038）认为 AP 可能降低出血复发的风险。AP 报告的副作用（28%）主要与喹诺酮类耐药的风险有关（62%的病例）。