Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Clin Microbiol Infect. 2021 Oct;27(10):1514.e5-1514.e10. doi: 10.1016/j.cmi.2021.01.014. Epub 2021 Jan 16.
Clinical evidence on prophylactic antibiotics for transarterial chemoembolization (TACE) to prevent liver abscess is limited because liver abscess is a rare event. This study aimed to analyse the association between prophylactic antibiotic use for TACE and the occurrence of liver abscess after TACE.
Using the nationwide Diagnosis Procedure Combination database in Japan, we retrospectively identified patients who underwent TACE for hepatic cancer between July 2010 and March 2017. The primary outcome was liver abscess requiring procedural intervention within 30 days of TACE. Secondary outcomes included 30-day in-hospital mortality and length of stay. Propensity score matching was performed to adjust for potential confounding factors and compare outcomes between patients with and without prophylactic antibiotics.
Among 167 544 eligible patients, 134 712 received antibiotics and 32 832 did not. In the matched cohort of 29 211 pairs, the proportion of patients with liver abscess requiring procedural intervention was significantly lower in the antibiotics group than in the no-antibiotics group (0.08% vs. 0.22%, p 0.001; relative risk (95% confidence interval), 0.35 (0.22-0.57); absolute risk reduction, 0.0014 (0.0008-0.0021); and number needed to treat, 696 (476-1223)). There was no significant difference in 30-day in-hospital mortality between the groups. The length of stay was longer in the antibiotics group than in the no-antibiotics group (median, 10 vs. 9 days, p < 0.001).
Prophylactic antibiotic use in patients undergoing TACE was associated with a reduced occurrence of liver abscess requiring procedural intervention.
经动脉化疗栓塞术（TACE）中预防性使用抗生素预防肝脓肿的临床证据有限，因为肝脓肿是一种罕见的事件。本研究旨在分析 TACE 中预防性使用抗生素与 TACE 后肝脓肿发生之间的关系。
我们使用日本全国诊断程序组合数据库，回顾性地确定了 2010 年 7 月至 2017 年 3 月期间接受肝癌 TACE 治疗的患者。主要结局是 TACE 后 30 天内需要程序性干预的肝脓肿。次要结局包括 30 天住院死亡率和住院时间。采用倾向评分匹配法调整潜在混杂因素，并比较使用和未使用预防性抗生素的患者的结局。
在 167544 名合格患者中，134712 名患者接受了抗生素治疗，32832 名患者未接受抗生素治疗。在 29211 对匹配队列中，抗生素组发生需要程序性干预的肝脓肿的患者比例明显低于未用抗生素组（0.08%比 0.22%，p<0.001；相对风险（95%置信区间），0.35（0.22-0.57）；绝对风险降低，0.0014（0.0008-0.0021）；需要治疗的人数，696（476-1223））。两组间 30 天住院死亡率无显著差异。抗生素组的住院时间长于未用抗生素组（中位数，10 天比 9 天，p<0.001）。
在接受 TACE 的患者中使用预防性抗生素与需要程序性干预的肝脓肿发生率降低相关。
