Ukai Tomohiko, Shikata Satoru, Inoue Machiko, Noguchi Yoshinori, Igarashi Hisato, Isaji Shuji, Mayumi Toshihiko, Yoshida Masahiro, Takemura Yousuke C
Department of Community Medicine, Mie University School of Medicine, Tsu, Mie, Japan.
J Hepatobiliary Pancreat Sci. 2015 Apr;22(4):316-21. doi: 10.1002/jhbp.221. Epub 2015 Feb 9.
The effectiveness of prophylactic antibiotics use for acute necrotizing pancreatitis has been explored and a number of systematic reviews have been published with conflicting results. The timing of antibiotics administration can be fundamental to their effectiveness, but thus far no reviews have focused on the timing of administration.
A systematic review of randomized controlled trials (RCTs) of prophylactic antibiotics for acute necrotizing pancreatitis was conducted using MEDLINE (PubMed), CINAHL and Japana Centra Revuo Medicina. Trials in which antibiotics were administered within 72 h after onset of symptoms or 48 h after admission were included. Our primary outcomes were the mortality rate and the incidence of infected pancreatic necrosis, and secondary outcomes were the incidence of non-pancreatic infection and the incidence of surgical intervention.
The search revealed six RCTs with a total of 397 patients. The mortality rates were significantly different for those taking antibiotics (7.4%), and controls (14.4%) (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.25-0.94). Also, early prophylactic antibiotics use was associated with reduced incidence of infected pancreatic necrosis (antibiotics 16.3%, controls 25.1%; OR, 0.55; 95% CI, 0.33-0.92).
Early use of prophylactic antibiotics for acute necrotizing pancreatitis is associated with reduced mortality and lower incidence of infected pancreatic necrosis.
预防性使用抗生素治疗急性坏死性胰腺炎的有效性已得到探讨，多项系统评价已发表，但结果相互矛盾。抗生素给药时机可能是其有效性的关键，但迄今为止尚无综述关注给药时机。
使用MEDLINE（PubMed）、CINAHL和日本医学中央杂志对预防性使用抗生素治疗急性坏死性胰腺炎的随机对照试验（RCT）进行系统评价。纳入症状出现后72小时内或入院后48小时内给予抗生素的试验。我们的主要结局是死亡率和感染性胰腺坏死的发生率，次要结局是非胰腺感染的发生率和手术干预的发生率。
检索发现六项RCT，共397例患者。使用抗生素者的死亡率（7.4%）与对照组（14.4%）有显著差异（优势比[OR]，0.48；95%置信区间[CI]，0.25 - 0.94）。此外，早期预防性使用抗生素与感染性胰腺坏死发生率降低相关（抗生素组16.3%，对照组25.1%；OR，0.55；95%CI，0.33 - 0.92）。
急性坏死性胰腺炎早期使用预防性抗生素与死亡率降低和感染性胰腺坏死发生率降低相关。
