一项全国性调查显示美国肝病专业人员在自发性细菌性腹膜炎预防方面面临两难困境。
A National Survey Shows a Dilemma Toward Spontaneous Bacterial Peritonitis Prophylaxis Among US-Based Hepatology Professionals.
作者信息
DiazGranados Deborah, O'Leary Jacqueline G, Yamuzala Madhumita, Rogal Shari, Bajaj Jasmohan S
机构信息
Psychiatry Department, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA.
Department of Medicine, University of Texas Southwestern Medical Center and Dallas VA Medical Center, Dallas, Texas, USA.
出版信息
Clin Transl Gastroenterol. 2025 May 13;16(7):e00858. doi: 10.14309/ctg.0000000000000858. eCollection 2025 Jul 1.
INTRODUCTION
Spontaneous bacterial peritonitis prophylaxis (SBPPr)-related practices are evolving, with recent studies showing almost half of potential subjects not being initiated on it. Determine practice dilemmas regarding SBPPr among US-based hepatology providers.
METHODS
A questionnaire regarding primary and secondary SBPPr using quantitative and qualitative (open-ended) approaches was sent to US-based hepatology providers electronically.
RESULTS
A total of 113 clinicians (86% physicians, 73% academic centers) responded. 54% started Primary and 72% secondary SBPPr in 50% of eligible patients. However, the issues related to antimicrobial resistance and ineffectiveness lead to SBPPr usage variations and restrictions on a patient-specific basis. Most respondents (>70%) would withdraw/not initiate SBPPr with data regarding ineffectiveness and harms. Open-ended answers showed that most believed newer trials to reduce reliance on weaker older evidence are needed.
DISCUSSION
A survey of US-based hepatologists demonstrates a major dilemma between usual care of initiating SBPPr versus not initiating/withdrawing SBPPr that needs newer randomized trials.
引言
自发性细菌性腹膜炎预防（SBPPr）相关的做法正在不断演变，最近的研究表明，几乎有一半的潜在受试者未开始接受该预防措施。确定美国肝病学提供者在SBPPr方面的实践困境。
方法
通过定量和定性（开放式）方法，以电子方式向美国肝病学提供者发送了一份关于原发性和继发性SBPPr的调查问卷。
结果
共有113名临床医生（86%为医生，73%来自学术中心）做出了回应。54%的医生在50%符合条件的患者中开始了原发性SBPPr，72%的医生开始了继发性SBPPr。然而，与抗菌药物耐药性和无效性相关的问题导致SBPPr的使用存在差异，并根据患者具体情况受到限制。大多数受访者（>70%）在有无效性和危害数据的情况下会停用/不开始使用SBPPr。开放式回答表明，大多数人认为需要进行更新的试验，以减少对较旧的、不太有力证据的数据依赖。
讨论
对美国肝病学家的一项调查表明，在开始进行SBPPr的常规治疗与不开始/停用SBPPr之间存在重大困境，这需要更新的随机试验。
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