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Profilaxis probiótica en la predicción de pancreatitis aguda severa: un ensayo aleatorizado, doble ciego, controlado
Marc Gh Besselink1, Hjalmar C van Santvoort1, Erik Buskens2
1Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Lancet (London, England)
|February 19, 2008
Resumen
La profilaxis probiótica no evitó las complicaciones infecciosas en la pancreatitis aguda grave y el aumento del riesgo de mortalidad. Evite los probióticos en estos pacientes debido al daño potencial, incluida la isquemia intestinal.
Área de la Ciencia:
- Gastroenterología y Gastroenterología.
- Medicina de cuidados críticos Medicina de cuidados críticos.
- Enfermedades infecciosas Enfermedades infecciosas.
Sus antecedentes:
- Las complicaciones infecciosas y la mortalidad son preocupaciones significativas en la pancreatitis aguda.
- Los probióticos enterales pueden prevenir las infecciones, pero la evidencia es limitada.
- Este estudio evaluó la profilaxis probiótica en la pancreatitis aguda severa prevista.
Objetivo del estudio:
- Evaluar la eficacia de la profilaxis probiótica en la reducción de las complicaciones infecciosas en pacientes con pancreatitis aguda severa prevista.
- Determinar el impacto de la profilaxis probiótica en las tasas de mortalidad en este grupo de pacientes.
Principales métodos:
- Un ensayo multicéntrico, aleatorizado, doble ciego, controlado con placebo que involucró a 298 pacientes con pancreatitis aguda severa prevista.
- Los pacientes recibieron una preparación probiótica multispecie o un placebo por vía enteral dos veces al día durante 28 días.
- El objetivo primario fue un compuesto de complicaciones infecciosas, con un seguimiento de 90 días.
Principales resultados:
- Las complicaciones infecciosas ocurrieron en el 30% del grupo probiótico frente al 28% del grupo placebo (RR 1,06, IC del 95% 0,75-1,51).
- La mortalidad fue significativamente mayor en el grupo de probióticos (16%) en comparación con el grupo de placebo (6%) (RR 2.53, IC del 95% 1.22-5.25).
- Nueve pacientes en el grupo de probióticos desarrollaron isquemia intestinal, con ocho resultados fatales, frente a ninguno en el grupo de placebo (p = 0,004).
Conclusiones:
- La profilaxis probiótica no redujo las complicaciones infecciosas en la pancreatitis aguda severa prevista.
- El uso de probióticos se asoció con una mayor mortalidad y un mayor riesgo de isquemia intestinal.
- La profilaxis probiótica no debe administrarse a pacientes con pancreatitis aguda severa con pronóstico.
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