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Role of Antibiotic Prophylaxis in Necrotizing Pancreatitis: A Meta-Analysis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Several studies have yielded conflicting results on the role of antibiotic prophylaxis in improving outcomes in acute necrotizing pancreatitis. A meta-analysis was carried out to investigate the impact of antibiotic prophylaxis in the incidence of infected pancreatic necrosis and mortality.

Methodology

Randomized controlled trials and cohort studies investigating impact of prophylactic systemic antibiotic used in acute necrotizing pancreatitis were retrieved from online databases. An overall analysis was done with all studies (Group 1), followed by subgroup analyses with randomized controlled trials (Group 2) and cohort studies (Group 3). Risk ratios (RR) were calculated for the impact of antibiotic prophylaxis in the incidence of infected pancreatic necrosis and mortality in each group using random effects model.

Results

Eleven studies involving 864 patients were included. No significant differences in the incidence of infected pancreatic necrosis were observed with prophylactic antibiotic use in all groups. Prophylactic antibiotic use was not associated with significant differences in all-cause mortality in Group 2 (RR = 0.75; p = 0.24) but was associated with a reduction in Groups 1 (RR = 0.66, p = 0.02) and 3 (RR = 0.55, p = 0.04). There was no statistical difference in the incidence of fungal infections and surgical interventions.

Conclusion

Antibiotic prophylaxis does not significantly reduce the incidence of infected pancreatic necrosis but may affect all-cause mortality in acute necrotizing pancreatitis.

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Acknowledgments

LC and TS reviewed the papers and carried out data analysis. LW, LY, CP, and AK conceived of the study and AK and LY helped draft the manuscript. All authors read and approved the final manuscript.

Conflicts of Interest and Source of Funding

The authors report no financial or other conflict of interest relevant to the subject of this article.

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Authors and Affiliations

  1. Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore

    Cheryl Li Ling Lim, Winnie Lee, Yi Xin Liew, Sarah Si Lin Tang & Andrea Lay-Hoon Kwa

  2. Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore

    Maciej Piotr Chlebicki

  3. Emerging Infectious Diseases, Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore

    Andrea Lay-Hoon Kwa

  4. Department of Pharmacy, Faculty of Science, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore

    Andrea Lay-Hoon Kwa

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  1. Cheryl Li Ling Lim
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Correspondence to Andrea Lay-Hoon Kwa.

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Lim, C.L.L., Lee, W., Liew, Y.X. et al. Role of Antibiotic Prophylaxis in Necrotizing Pancreatitis: A Meta-Analysis. J Gastrointest Surg 19, 480–491 (2015). https://doi.org/10.1007/s11605-014-2662-6

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  • DOI: https://doi.org/10.1007/s11605-014-2662-6

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