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评估肝硬化合并上消化道出血患者抗生素预防的临床终点：一项更新的系统评价和荟萃分析。

Evaluating the Clinical Endpoint of Antibiotic Prophylaxis for Cirrhosis Patients Complicated with Upper Gastrointestinal Bleeding: An Updated Systematic Review and Meta-analysis.

作者信息

Dewi Putu Itta Sandi Lesmana, Pamungkas Kadek Mercu Narapati, Dewi Ni Luh Putu Yunia, Dewi Ni Nyoman Gita Kharisma, Sindhughosa Dwijo Anargha, Mariadi I Ketut

机构信息

Centre Research for Alimentary and Hepatobiliary System, Bali, Indonesia.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine Udayana University - Prof. Dr. I.G.N.G. Ngoerah General Hospital, Bali, Indonesia.

出版信息

Acta Med Philipp. 2025 Jun 30;59(8):77-86. doi: 10.47895/amp.vi0.10174. eCollection 2025.

DOI:10.47895/amp.vi0.10174
PMID:40755561
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12314439/
Abstract

BACKGROUND AND OBJECTIVE

Antibiotic prophylaxis is used to prevent bacterial infections and rebleeding in cirrhosis patients with upper gastrointestinal bleeding (UGIB). However, the effects of various antibiotics on patients with UGIB are still being considered. This study aims to evaluate the effect of antibiotic prophylaxis on cirrhosis patients with UGIB.

METHODS

The studies were searched through databases of PubMed, ScienceDirect, Wiley Online Library, and CENTRAL from 2013 to 2023. We used Revman 5.4 to perform a meta-analysis. I2 statistics measured the heterogeneity test. The odds ratio (OR) and 95% confidence interval (CI) were used to assess the effect of antibiotic prophylaxis.

RESULTS

Twelve studies involving 14,825 cirrhosis patients were included in this study. Based on the meta-analysis, antibiotic prophylaxis significantly lowered the bacterial infection rate (OR: 0.29, 95%CI: 0.10 to 0.84, = 0.02), and the incidence of serious adverse events (SAE) (OR: 0.50, 95%CI: 0.28 to 0.88, = 0.02) in cirrhosis patients with UGIB.

CONCLUSIONS

Administration of antibiotics demonstrated a significant reduction in bacterial infection rates and SAEs. Broad-spectrum non-absorbable antibiotics can be used in cirrhosis patients with UGIB. The appropriate use of antibiotics is important to prevent resistance.

摘要

背景与目的

抗生素预防用于预防肝硬化合并上消化道出血（UGIB）患者的细菌感染和再出血。然而，各种抗生素对UGIB患者的影响仍在探讨中。本研究旨在评估抗生素预防对肝硬化合并UGIB患者的效果。

方法

通过检索2013年至2023年的PubMed、ScienceDirect、Wiley Online Library和CENTRAL数据库获取相关研究。我们使用Revman 5.4进行荟萃分析。I²统计量用于衡量异质性检验。比值比（OR）和95%置信区间（CI）用于评估抗生素预防的效果。

结果

本研究纳入了12项涉及14825例肝硬化患者的研究。基于荟萃分析，抗生素预防显著降低了肝硬化合并UGIB患者的细菌感染率（OR：0.29，95%CI：0.10至0.84，P = 0.02）以及严重不良事件（SAE）的发生率（OR：0.50，95%CI：0.28至0.88，P = 0.02）。

结论

使用抗生素可显著降低细菌感染率和严重不良事件的发生率。广谱不可吸收抗生素可用于肝硬化合并UGIB的患者。合理使用抗生素对于预防耐药性很重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e45/12314439/3090f7e7e6c9/AMP-59-8-10174-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e45/12314439/65b6248de715/AMP-59-8-10174-g001.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e45/12314439/6d5c397adf41/AMP-59-8-10174-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e45/12314439/82341f3d95c5/AMP-59-8-10174-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e45/12314439/95b758ede3b9/AMP-59-8-10174-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e45/12314439/3090f7e7e6c9/AMP-59-8-10174-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e45/12314439/65b6248de715/AMP-59-8-10174-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e45/12314439/36cad0bf0af0/AMP-59-8-10174-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e45/12314439/6d5c397adf41/AMP-59-8-10174-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e45/12314439/82341f3d95c5/AMP-59-8-10174-g004.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e45/12314439/3090f7e7e6c9/AMP-59-8-10174-g006.jpg

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本文引用的文献

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The effect of prophylactic antibiotics in acute upper gastrointestinal bleeding patients in the emergency department.预防性抗生素对急诊科急性上消化道出血患者的影响。
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Prophylactic antibiotics on patients with cirrhosis and upper gastrointestinal bleeding: A meta-analysis.预防性抗生素治疗肝硬化合并上消化道出血患者：一项荟萃分析。
PLoS One. 2022 Dec 22;17(12):e0279496. doi: 10.1371/journal.pone.0279496. eCollection 2022.
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Management of varices and variceal hemorrhage in liver cirrhosis: a recent update.
肝硬化中静脉曲张及静脉曲张出血的管理：近期进展
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Antibiotics and Liver Cirrhosis: What the Physicians Need to Know.抗生素与肝硬化：医生需要了解的内容
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Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice.肝硬化患者的抗生素预防：临床实践的当前证据
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Primary prevention of variceal bleeding in people with oesophageal varices due to liver cirrhosis: a network meta-analysis.肝硬化食管静脉曲张患者的静脉曲张出血一级预防：网络荟萃分析。
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Universal antibiotic prophylaxis may no longer be necessary for patients with acute variceal bleeding: A retrospective observational study.急性静脉曲张出血患者可能不再需要全身性抗生素预防：一项回顾性观察研究。
Medicine (Baltimore). 2020 May;99(20):e19981. doi: 10.1097/MD.0000000000019981.
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Limited effects of antibiotic prophylaxis in patients with Child-Pugh class A/B cirrhosis and upper gastrointestinal bleeding.肝硬化 Child-Pugh 分级 A/B 级患者和上消化道出血应用抗生素预防的效果有限。
PLoS One. 2020 Feb 21;15(2):e0229101. doi: 10.1371/journal.pone.0229101. eCollection 2020.
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