Systematic Review with Trial Sequential Analysis of Prophylactic Antibiotics for Acute Pancreatitis

Poropat, Goran; Goričanec, Karla; Lacković, Alojzije; Kresović, Andrea; Lončarić, Antun; Marušić, Martina

doi:10.3390/antibiotics11091191

Cited by 10 publications

(11 citation statements)

References 42 publications

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“…However, conflicting results have been reported in the literature due to different methodologies ( 22 ). Most published studies supported that there may be a negative association between antibiotic prophylaxis and the risk of necrotic tissue infection ( 19 - 21 ). In 2010, Villatoro et al reported that prophylactic imipenem, unlike other antibiotics, reduces the risk of pancreatic infection ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

“…The effect of prophylaxis on non-pancreatic infections is controversial. Although some meta-analyses determined that prophylaxis reduced the infection, especially urinary tract infections and sepsis ( 19 , 20 ), some meta-analyses found antibiotic prophylaxis did not affect infection ( 21 ). Our meta-analysis showed that carbapenems were related to a lower risk of non-pancreatic infection risk in all subgroup analyses.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Prophylactic Carbapenem Use on Outcomes in Acute Pancreatitis: A Systematic Review and Meta-Analysis

Buyukkoruk,

Senturk,

Ozger

2023

Infect Dis Clin Microbiol

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Objective: This study aimed to determine the effect of prophylactic use of carbapenems for acute pancreatitis on clinical outcomes. Materials and Methods: It was conducted according to the preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using the keywords “Pancrea* AND carbapenem OR imipenem OR ertapenem OR meropenem OR doripenem.” Primer outcomes were mortality, surgical intervention, and pancreatic and non-pancreatic infection. Subgroup analyses were also performed to reduce the risk of bias. Results: Ten studies with 4038 patients were included in the meta-analyses. While eight of ten were randomized controlled trials, two were observational studies. The prophylactic use of carbapenems had no statistically significant effect on mortality (OR=0.82, 95% CI=0.65-1.04, I²=0%) and surgical intervention. (OR=0.81, 95% CI=0.57-1.17, I²=0%). However, the real impact of prophylaxis on reducing the incidence of mortality and surgical intervention was uncertain due to the insufficient sample size. The prophylactic use of carbapenems was significantly associated with a lower risk of peripancreatic (OR=0.37, 95% CI=0.25-0.55, I²=61%) and non-pancreatic infection risk (OR=0.60, 95% CI=0.46-0.78, I²=65%). The definitions of infection in the articles were not clear, and the diagnostic approach to infection was based on subjective criteria. In addition, there was inadequate collateral damage and safety assessments. In high-quality studies with a low risk of bias, prophylactic carbapenems had no effect on peripancreatic infection (RR=1.54, 95% CI=0.65-3.47, I²=0%) and non-pancreatic infection (RR=0.72, 95% CI=0.48-1.07, I²=0%). Conclusion: Although there is a reduction in the infection risk, routine carbapenem use in acute pancreatitis cases should not be recommended based on current evidence. Cooperation with Infectious Disease specialists and developing diagnostic algorithms are required instead of routine prophylaxis to prevent infection, especially non-pancreatic infection. Keywords: acute pancreatitis, necrotizing pancreatitis, carbapenem, prophylaxis, systematic review, meta-analysis

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Effect of Prophylactic Carbapenem Use on Outcomes in Acute Pancreatitis: A Systematic Review and Meta-Analysis

Buyukkoruk,

Senturk,

Ozger

2023

Infect Dis Clin Microbiol

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“…Діагностика, зокрема оцінка тяжкості стану дитини з гострим деструктивним панкреатитом, і навіть лікувальна тактика, залишаються предметом дискусії. Загальні діагностичні маркери, як-то -визначення активності панкреатичних ферментів у крові, сечі, перитонеальному та торакальному секреті, динаміка гомеостатичних показників, а також комплексне інструментальне обстеження (УЗД органів живота, комп'ютерна томографія та магнітно-резонансна томографія, відеохірургічна діагностика), є стандартними як щодо дорослого, так і щодо педіатричного стаціонару [2,3,4,8,12,19,22,23]. У той же час ендоскопічна візуалізація фатерова сосочка та ретроградна панкреатохолангіографія (ЕРПХГ), а за показаннями -ендоскопічна дуоденопапілотомія, не знайшли належного застосування в умовах дитячого хірургічного стаціонару [9,13].…”

Section: вступunclassified

“…Так само, на відміну від дорослих пацієнтів, має свої особливості лікувальна тактика у дітей із гострим деструктивним панкреатитом. Статистичні дослідження свідчать, що загальна летальність у дітей із гострим панкреатитом становить 2,1%, а у дітей із гострим деструктивним панкреатитом летальність сягає 50% [17,19,23].…”

Section: вступunclassified

“…Вважається, що основою вибору антибактеріальних препаратів є мікробіологічні дослідження. Насправді ж превалює емпіричне призначення антибіотиків широкого спектру дії, зокрема "профілактичних", і потенціація антибактеріального ефекту препаратами метронідазолу [23]. Препаратами вибору (базис-терапії) є карбапенеми, фторхінолони та β-лактамні антибіотики (цефалоспорини IV-V покоління).…”

Section: обговоренняunclassified

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Acute Destructive Pancreatitis in Children

Veselyy,

Galinskij

2023

Neonatol. hìr. perinat. med.

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Unlike adults, acute pancreatitis in children is a rare disease. The absence of unified standards for the diagnosis, treatment and rehabilitation of children with acute destructive pancreatitis, as well as high rates of complications and mortality, determined the relevance of our study.Materials and methods. Materials and methods. The results of treatment of 11 children with acute destructive pancreatitis were studied. The age of the patients ranged from 2 to 16 years. Laboratory examination in all patients included general and biochemical analyzes of blood, urine, peritoneal and thoracic exudate. All children underwent an ultrasound examination of the abdomen, chest cavity and mediastinum, and plain radiography of the chest and abdominal cavity. Computed tomography was performed in 6 patients (54.5%). Fibrogastroduodenoscopy (FGDS) was performed in 3 patients (27.3%). All patients underwent surgery. In 8 cases (72.7%), a median laparotomy was performed initially. In 3 observations (27.3%), surgical treatment began with video surgical revision of the abdominal organs, and then switched to conversion. Three patients (27.3%) subsequently underwent cystopancreatic jejunostomy. In one child, transcutaneous drainage of a false pancreatic cyst was performed under video surgical control. Synthetic somatostatin analogs and proteinase inhibitors were used as targeted therapy. All patients received long-term antibacterial therapy. Various methods of extracorporeal detoxification were used in 6 patients (54.5%).Statistical processing of the research results was carried out using standard methods with the calculation of relative values (absolute number of observations, % ratio).The approval of the scientific work was received from the Bioethical Commission of the Donetsk National Medical University (Ukraine).The work is a fragment of proactive research work of the Department of General and Children's Surgery of the Donetsk National Medical University (Ukraine). Results. Complications in the early postoperative period were noted in 8 children (72.7%). The group of the most severe complications included progressive enzymatic bacterial peritonitis, early adhesive intestinal obstruction, failure of cystopancreatic ileal anastomosis, profuse arrosive hemorrhage from the pancreas, cystopancreaticodigestive fistula and eventation. In the early postoperative period, 1 child aged 14 years (9.1%) died, and the rest of the patients were discharged in satisfactory condition. The average hospital stay for children was 23.1 days. In 7 patients (63.6%), complaints characterized by "enteric" discomfort occurred later.Conclusions. The principles of surgical and therapeutic tactics in children with acute destructive pancreatitis are based on a differentiated approach depending on the form of pancreatic necrosis and the development of purulent and destructive complications. Further study requires determination of situational surgical tactics, assessment of the effectiveness of combined therapy with somatostatin and proteinase inhibitors, selection of the optimal regimen of nutritional therapy and rehabilitation.

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Letter Re: Real-world outcomes of Italian patients with advanced non-squamous lung cancer treated with first-line pembrolizumab plus platinum-pemetrexed

Zhu,

Wang,

Liu

2024

European Journal of Cancer

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Systematic Review with Trial Sequential Analysis of Prophylactic Antibiotics for Acute Pancreatitis

Cited by 10 publications

References 42 publications

The Effect of Prophylactic Carbapenem Use on Outcomes in Acute Pancreatitis: A Systematic Review and Meta-Analysis

The Effect of Prophylactic Carbapenem Use on Outcomes in Acute Pancreatitis: A Systematic Review and Meta-Analysis

Acute Destructive Pancreatitis in Children

Letter Re: Real-world outcomes of Italian patients with advanced non-squamous lung cancer treated with first-line pembrolizumab plus platinum-pemetrexed

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