Effect of meta-analysis in prophylactic use of antibiotics in patients with severe acute pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 GONG Haijun ¹ , HE Jufang ² , LU Cuncun ³ , YUE Weigang ² , TIAN Jinhui ³

1. Gansu Emergency Medical Aid Center, Lanzhou 730030, P. R. China;
2. Department of Oncology Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;
3. Evidence Based Medicine Center, Lanzhou University, Lanzhou 730000, P. R. China;

Corresponding?author：

GONG Haijun, Email: 772138168@qq.com

Keywords：

severe acute pancreatitis; prophylactic use of antibiotics; meta-analysis

DOI：

10.7507/1007-9424.201804030

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Objective To perform a systematic review and meta-analysis to evaluate the efficacy and safety of prophylactic use of antibiotics in preventing severe acute pancreatitis. Methods Randomized control trials (RCTs) of prophylactic use of antibiotics were identified from PubMed, EMbase, Cochrane Library, Web of Science, CNKI, Wangfang Database, and handly searched related literatures. The retrieval time was from inception to Dec. 2017. All the data would be analysis with the software RevMan 5.3. Results Eventually 16 RCTs of 999 participants were involved, the patients were divided into two groups: the intervention group (prophylactic use of antibiotics, n=501) and the control group (n=498). The result of meta-analysis showed that, the incidence rate of pancreatitis infectious disease and the incidence rate of peripancreatitis infectious were significant lower in the intervention group than the control group, whose OR were amount to 0.68 ［95% CI was (0.50, 0.93), P=0.02］ and 0.63 ［95% CI was (0.45, 0.88), P=0.007］ respectively. Meanwhile, concerning the rate of surgery intervention ［OR=0.79, 95% CI was (0.57, 1.08), P=0.14］ and in mortality rate ［OR=0.81, 95% CI was (0.56, 1.15), P=0.24］, there was no statistically significant. Conclusion Prophylactic antibiotic treatment can do benefit to reduce the incidence rate of pancreatitis infectious and the rate of peripancreatitis infectious disease, but can not reduce mortality in patients with severe acute pancreatitis and had no significant protective effect in patients in reducing the rate of surgery intervention and mortality rate.

Citation： GONG Haijun, HE Jufang, LU Cuncun, YUE Weigang, TIAN Jinhui. Effect of meta-analysis in prophylactic use of antibiotics in patients with severe acute pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(10): 1218-1226. doi: 10.7507/1007-9424.201804030 Copy

1.	王春友, 楊明. 《急性胰腺炎診治指南 (2014)》解讀—急性胰腺炎外科診治現狀與進展. 中國實用外科雜志, 2015, 35(1): 8-10.
2.	Jiang K, Huang W, Yang XN, et al. Present and future of prophylactic antibiotics for severe acute pancreatitis. World J Gastroenterol, 2012, 18(3): 279-284.
3.	Lim CL, Lee W, Liew YX, et al. Role of antibiotic prophylaxis in necrotizing pancreatitis: a meta-analysis. J Gastrointest Surg, 2015, 19(3): 480-491.
4.	Lankisch PG, Banks PA. Acute pancreatitis: treatment//Lankisch PG, Banks PA. Pancrestitis. Berlin: Springer, 1998: 145-182.
5.	Pederzoli P, Bassi C, Vesentini S, et al. A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet, 1993, 176(5): 480-483.
6.	Isaji S, Takada T, Mayumi T, et al. Revised Japanese guidelines for the management of acute pancreatitis 2015: revised concepts and updated points. J Hepatobiliary Pancreat Sci, 2015, 22(6): 433-445.
7.	Wittau M, Hohl K, Mayer J, et al. The weak evidence base for antibiotic prophylaxis in severe acute pancreatitis. Hepatogastroenterology, 2008, 55(88): 2233-2237.
8.	Higgens JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. 2018-04-09. https://onlinelibrary.wiley.com/doi/book/10.1002/9780470712184.
9.	劉立剛, 劉務華, 姚鵬飛, 等. ω-3 不飽和脂肪酸乳劑在腸外營養中對胃腸道惡性腫瘤術后短期療效的 meta 分析. 中國普外基礎與臨床雜志, 2015, 22(11): 1338-1346.
10.	胡雁. 循證護理學. 北京: 人民衛生出版社, 2012: 112.
11.	劉鳴. 系統評價、Meta-分析設計與實施方法. 北京: 人民衛生出版社, 2011: 98-117.
12.	Sainio V, Kemppainen E, Puolakkainen P, et al. Early antibiotic treatment in acute necrotising pancreatitis. Lancet, 1995, 346(8976): 663-667.
13.	Delcenserie R, Yzet T, Ducroix JP. Prophylactic antibiotics in treatment of severe acute alcoholic pancreatitis. Pancreas, 1996, 13(2): 198-201.
14.	Schwarz M, Isenmann R, Meyer H, et al. Antibiotic use in necrotizing pancreatitis. Results of a controlled study. Dtsch Med Wochenschr, 1997, 122(12): 356-361.
15.	Nordback I, Sand J, Saaristo R, et al. Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis-a single-center randomized study. J Gastrointest Surg, 2001, 5(2): 113-118.
16.	Isenmann R, Rünzi M, Kron M, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial. Gastroenterology, 2004, 126(4): 997-1004.
17.	Spicak J, Hejtmankova S, Cech P, et al. Antibiotic prophylaxis in large pancreatic necrosis: multicenter randomized trial with ciprofloxacin and metronidazole or meropenem. Gastroenterology, 2004, 126(Suppl 2): A229.
18.	Dellinger EP, Tellado JM, Soto NE, et al. Early antibiotic treatment for severe acute necrotizing pancreatitis: a randomized, double-blind, placebo-controlled study. Ann Surg, 2007, 245(5): 674-683.
19.	R?kke O, Harbitz TB, Liljedal J, et al. Early treatment of severe pancreatitis with imipenem: a prospective randomized clinical trial. Scand J Gastroenterol, 2007, 42(6): 771-776.
20.	García-Barrasa A, Borobia FG, Pallares R, et al. A double-blind, placebo-controlled trial of ciprofloxacin prophylaxis in patients with acute necrotizing pancreatitis. J Gastrointest Surg, 2009, 13(4): 768-774.
21.	Xue P, Deng LH, Zhang ZD, et al. Infectious complications in patients with severe acute pancreatitis. Dig Dis Sci, 2009, 54(12): 2748-2753.
22.	Barreda L, Targarona J, Milian W, et al. Is the prophylactic antibiotic therapy with Imipenem effective for patients with pancreatic necrosis? Acta Gastroenterol Latinoam, 2009, 39(1): 24-29.
23.	賈光, 孫備, 李軍, 等. 早期應用莫西沙星治療重癥急性胰腺炎. 中國實用外科雜志, 2011, 31(1): 23-25.
24.	Llukacaj A, Naco M, Mandi A, et al. Prophylactic antibiotic treatment for severe acute necrotizing pancreatitis. European J Anaesthesiology, 2012, (29): 28.
25.	李鴻, 姚晶, 羅德富. 重癥急性胰腺炎預防性抗生素應用療效分析. 中國醫藥導刊, 2014, 16(3): 544-545.
26.	Poropat G, Giljaca V. Imipenem prophylaxis for predicted severe acute pancreatitis-preliminary results of a randomized clinical trial. Pancrealogy, 2015, 16: S89.
27.	Ellenberg SS. Meta-analysis: the quantitative approach to research review. Semin Oncol, 1988, 15(5): 472-481.
28.	楊尹默, 陳依然. 《日本急性胰腺炎治療指南 (2015)》評介. 中國實用外科雜志, 2016, 36(1): 75-78.
29.	曹鋒, 李非. 再論重癥急性胰腺炎感染及預防性抗生素的合理應用. 肝膽胰外科雜志, 2011, 23(1): 77-79, 83.
30.	Mourad MM, Evans R, Kalidindi V, et al. Prophylactic antibiotics in acute pancreatitis: endless debate. Ann R Coll Surg Engl, 2017, 99(2): 107-112.

1. 王春友, 楊明. 《急性胰腺炎診治指南 (2014)》解讀—急性胰腺炎外科診治現狀與進展. 中國實用外科雜志, 2015, 35(1): 8-10.
2. Jiang K, Huang W, Yang XN, et al. Present and future of prophylactic antibiotics for severe acute pancreatitis. World J Gastroenterol, 2012, 18(3): 279-284.
3. Lim CL, Lee W, Liew YX, et al. Role of antibiotic prophylaxis in necrotizing pancreatitis: a meta-analysis. J Gastrointest Surg, 2015, 19(3): 480-491.
4. Lankisch PG, Banks PA. Acute pancreatitis: treatment//Lankisch PG, Banks PA. Pancrestitis. Berlin: Springer, 1998: 145-182.
5. Pederzoli P, Bassi C, Vesentini S, et al. A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet, 1993, 176(5): 480-483.
6. Isaji S, Takada T, Mayumi T, et al. Revised Japanese guidelines for the management of acute pancreatitis 2015: revised concepts and updated points. J Hepatobiliary Pancreat Sci, 2015, 22(6): 433-445.
7. Wittau M, Hohl K, Mayer J, et al. The weak evidence base for antibiotic prophylaxis in severe acute pancreatitis. Hepatogastroenterology, 2008, 55(88): 2233-2237.
8. Higgens JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. 2018-04-09. https://onlinelibrary.wiley.com/doi/book/10.1002/9780470712184.
9. 劉立剛, 劉務華, 姚鵬飛, 等. ω-3 不飽和脂肪酸乳劑在腸外營養中對胃腸道惡性腫瘤術后短期療效的 meta 分析. 中國普外基礎與臨床雜志, 2015, 22(11): 1338-1346.
10. 胡雁. 循證護理學. 北京: 人民衛生出版社, 2012: 112.
11. 劉鳴. 系統評價、Meta-分析設計與實施方法. 北京: 人民衛生出版社, 2011: 98-117.
12. Sainio V, Kemppainen E, Puolakkainen P, et al. Early antibiotic treatment in acute necrotising pancreatitis. Lancet, 1995, 346(8976): 663-667.
13. Delcenserie R, Yzet T, Ducroix JP. Prophylactic antibiotics in treatment of severe acute alcoholic pancreatitis. Pancreas, 1996, 13(2): 198-201.
14. Schwarz M, Isenmann R, Meyer H, et al. Antibiotic use in necrotizing pancreatitis. Results of a controlled study. Dtsch Med Wochenschr, 1997, 122(12): 356-361.
15. Nordback I, Sand J, Saaristo R, et al. Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis-a single-center randomized study. J Gastrointest Surg, 2001, 5(2): 113-118.
16. Isenmann R, Rünzi M, Kron M, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial. Gastroenterology, 2004, 126(4): 997-1004.
17. Spicak J, Hejtmankova S, Cech P, et al. Antibiotic prophylaxis in large pancreatic necrosis: multicenter randomized trial with ciprofloxacin and metronidazole or meropenem. Gastroenterology, 2004, 126(Suppl 2): A229.
18. Dellinger EP, Tellado JM, Soto NE, et al. Early antibiotic treatment for severe acute necrotizing pancreatitis: a randomized, double-blind, placebo-controlled study. Ann Surg, 2007, 245(5): 674-683.
19. R?kke O, Harbitz TB, Liljedal J, et al. Early treatment of severe pancreatitis with imipenem: a prospective randomized clinical trial. Scand J Gastroenterol, 2007, 42(6): 771-776.
20. García-Barrasa A, Borobia FG, Pallares R, et al. A double-blind, placebo-controlled trial of ciprofloxacin prophylaxis in patients with acute necrotizing pancreatitis. J Gastrointest Surg, 2009, 13(4): 768-774.
21. Xue P, Deng LH, Zhang ZD, et al. Infectious complications in patients with severe acute pancreatitis. Dig Dis Sci, 2009, 54(12): 2748-2753.
22. Barreda L, Targarona J, Milian W, et al. Is the prophylactic antibiotic therapy with Imipenem effective for patients with pancreatic necrosis? Acta Gastroenterol Latinoam, 2009, 39(1): 24-29.
23. 賈光, 孫備, 李軍, 等. 早期應用莫西沙星治療重癥急性胰腺炎. 中國實用外科雜志, 2011, 31(1): 23-25.
24. Llukacaj A, Naco M, Mandi A, et al. Prophylactic antibiotic treatment for severe acute necrotizing pancreatitis. European J Anaesthesiology, 2012, (29): 28.
25. 李鴻, 姚晶, 羅德富. 重癥急性胰腺炎預防性抗生素應用療效分析. 中國醫藥導刊, 2014, 16(3): 544-545.
26. Poropat G, Giljaca V. Imipenem prophylaxis for predicted severe acute pancreatitis-preliminary results of a randomized clinical trial. Pancrealogy, 2015, 16: S89.
27. Ellenberg SS. Meta-analysis: the quantitative approach to research review. Semin Oncol, 1988, 15(5): 472-481.
28. 楊尹默, 陳依然. 《日本急性胰腺炎治療指南 (2015)》評介. 中國實用外科雜志, 2016, 36(1): 75-78.
29. 曹鋒, 李非. 再論重癥急性胰腺炎感染及預防性抗生素的合理應用. 肝膽胰外科雜志, 2011, 23(1): 77-79, 83.
30. Mourad MM, Evans R, Kalidindi V, et al. Prophylactic antibiotics in acute pancreatitis: endless debate. Ann R Coll Surg Engl, 2017, 99(2): 107-112.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of meta-analysis in prophylactic use of antibiotics in patients with severe acute pancreatitis

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