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, 杨明. 《急性胰腺炎诊治指南 (2014)》解读—急性胰腺炎外科诊治现状与进展. 中国实用外科杂志, 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.	刘立刚, 刘务华, 姚鹏飞, 等. ω-3 不饱和脂肪酸乳剂在肠外营养中对胃肠道恶性肿瘤术后短期疗效的 meta 分析. 中国普外基础与临床杂志, 2015, 22(11): 1338-1346.
10.	胡雁. 循证护理学. 北京: 人民卫生出版社, 2012: 112.
11.	刘鸣. 系统评价、Meta-分析设计与实施方法. 北京: 人民卫生出版社, 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.	Røkke 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.	贾光, 孙备, 李军, 等. 早期应用莫西沙星治疗重症急性胰腺炎. 中国实用外科杂志, 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.	李鸿, 姚晶, 罗德富. 重症急性胰腺炎预防性抗生素应用疗效分析. 中国医药导刊, 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.	杨尹默, 陈依然. 《日本急性胰腺炎治疗指南 (2015)》评介. 中国实用外科杂志, 2016, 36(1): 75-78.
29.	曹锋, 李非. 再论重症急性胰腺炎感染及预防性抗生素的合理应用. 肝胆胰外科杂志, 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, 杨明. 《急性胰腺炎诊治指南 (2014)》解读—急性胰腺炎外科诊治现状与进展. 中国实用外科杂志, 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. 刘立刚, 刘务华, 姚鹏飞, 等. ω-3 不饱和脂肪酸乳剂在肠外营养中对胃肠道恶性肿瘤术后短期疗效的 meta 分析. 中国普外基础与临床杂志, 2015, 22(11): 1338-1346.
10. 胡雁. 循证护理学. 北京: 人民卫生出版社, 2012: 112.
11. 刘鸣. 系统评价、Meta-分析设计与实施方法. 北京: 人民卫生出版社, 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. Røkke 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. 贾光, 孙备, 李军, 等. 早期应用莫西沙星治疗重症急性胰腺炎. 中国实用外科杂志, 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. 李鸿, 姚晶, 罗德富. 重症急性胰腺炎预防性抗生素应用疗效分析. 中国医药导刊, 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. 杨尹默, 陈依然. 《日本急性胰腺炎治疗指南 (2015)》评介. 中国实用外科杂志, 2016, 36(1): 75-78.
29. 曹锋, 李非. 再论重症急性胰腺炎感染及预防性抗生素的合理应用. 肝胆胰外科杂志, 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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