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Meta-Analysis
. 2020 Jan 20;133(2):212-220.
doi: 10.1097/CM9.0000000000000603.

Assessment of prophylactic antibiotics administration for acute pancreatitis: a meta-analysis of randomized controlled trials

Nan Ding  1 , Yong-Hui Sun  2 , Li-Mei Wen  1 , Jian-Hua Wang  1 , Jian-Hua Yang  1 , Kun Cheng  2 , Hai Lin  2 , Qi-Long Chen  2
Affiliations
Meta-Analysis

Assessment of prophylactic antibiotics administration for acute pancreatitis: a meta-analysis of randomized controlled trials

Nan Ding et al. Chin Med J (Engl). .

Abstract

Background: Recent evidence has shown that prophylactic antibiotic treatment in patients with acute pancreatitis is not associated with a significant decrease in mortality or morbidity. The use and efficacy of prophylactic antibiotic treatment in acute pancreatitis remain controversial. This meta-analysis was conducted to assess whether antibiotic prophylaxis is beneficial in patients with acute pancreatitis.

Methods: We searched randomized controlled trials (RCTs) of prophylactic use of antibiotics using Medline (PubMed), Embase, the Cochrane Library, and Web of Science. The data were analyzed using Review Manager 5.3 software. We performed pooled analyses for infected pancreatic necrosis, mortality, surgical intervention, and non-pancreatic infection. Odds ratios (ORs) from each trial were pooled using a random or fixed effects model, depending on the heterogeneity of the included studies. Sub-group analysis or sensitivity analysis was conducted to explore potential sources of heterogeneity, when necessary.

Results: Totally, 11 RCTs involving 747 participants were included, with an intervention group (prophylactic use of antibiotics, n = 376) and control group (n = 371). No significant differences were found regarding antibiotic prophylaxis with respect to incidence of infected pancreatic necrosis (OR, 0.74; 95% confidence interval [CI], 0.50-1.09; P = 0.13), surgical intervention (OR, 0.92; 95% CI, 0.62-1.38; P = 0.70), and morality (OR, 0.71; 95% CI, 0.44-1.15; P = 0.16). However, antibiotic prophylaxis was associated with a statistically significant reduction in the incidence of non-pancreatic infection (OR, 0.59; 95% CI, 0.42-0.84; P = 0.004).

Conclusions: Prophylactic antibiotics can reduce the incidence of non-pancreatic infection in patients with AP.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Flow diagram for the selection of randomized controlled trials included in the meta-analysis.
Figure 2
Figure 2
Risk of bias summary: review authors’ judgments about each risk of bias item for each included study. Red indicates “high risk,” green “low risk,” and yellow “unclear risk.”
Figure 3
Figure 3
Forest plot of comparison: antibiotic prophylactic effect on infected pancreatic necrosis. CI: Confidence interval; M-H: Mantel-Haenszel.
Figure 4
Figure 4
Forest plot of comparison: antibiotic prophylactic effect on mortality. CI: Confidence interval; M-H: Mantel-Haenszel.
Figure 5
Figure 5
Forest plot of comparison: antibiotic prophylactic effect on surgical intervention. CI: Confidence interval; M-H: Mantel-Haenszel.
Figure 6
Figure 6
Forest plot of comparison: antibiotic prophylactic effect on non-pancreatic infection. CI: Confidence interval; M-H: Mantel-Haenszel.
Figure 7
Figure 7
Egger's test illustrating the publication bias. CI: Confidence interval.
Figure 8
Figure 8
The sensitivity analysis for the incidence of non-pancreatic infections. CI: Confidence interval.
Figure 9
Figure 9
The sub-group analysis for the incidence of non-pancreatic infections. (A) Forest plot showing OR for non-pancreatic infections based on publication date of included RCTs. (B) Forest plot showing unadjusted OR for non-pancreatic infections based on sample size. (C) Forest plot showing OR for non-pancreatic infections based on single-center or multiple centers. (D) Forest plot showing OR for non-pancreatic infections based on kinds of antibiotics. CI: Confidence interval; M-H: Mantel-Haenszel; OR: Odds ratio; RCT: Randomized controlled trial.
Figure 10
Figure 10
Forest plot of comparison: antibiotic prophylactic effect on pneumonia. CI: Confidence interval; M-H: Mantel-Haenszel.
Figure 11
Figure 11
Forest plot of comparison: antibiotic prophylactic effect on positive blood culture. CI: Confidence interval; M-H: Mantel-Haenszel.
Figure 12
Figure 12
Forest plot of comparison: antibiotic prophylactic effect on fungal infection. CI: Confidence interval; M-H: Mantel-Haenszel.
Figure 13
Figure 13
Forest plot of comparison: antibiotic prophylactic effect on urinary tract infection. CI: Confidence interval; M-H: Mantel-Haenszel.
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