在急性胰腺炎中适当使用抗生素:范围审查
Josep M Badia1, Sara Amador1, Carmen González-Sánchez2
1Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain.
抗生素对于治疗急性胰腺炎 (AP) 感染性胰腺亡 (IPN) 非常重要,但不应用于预防. 早期,有针对性的抗生素治疗可以降低死亡率,而预防性使用不建议.
科学领域:
- 传染性疾病 传染性疾病
- 胃肠病学 胃肠病学
- 关键护理医学 关键护理医学
背景情况:
- 在急性胰腺炎 (AP) 中,建议选择性抗生素用于感染胰腺亡 (IPN).
- 现有的研究表明,IPN的治疗不充分的发病率很高.
- 抗生素耐药性和真菌感染是与预防使用相关的重大风险.
研究的目的:
- 审查当前关于在感染性胰腺瘤 (IPN) 中使用抗生素的证据.
- 澄清预防性抗生素与治疗性抗生素在急性胰腺炎 (AP) 中的作用.
- 确定IPN的最佳诊断和管理策略.
主要方法:
- 在PubMed,Scopus和Cochrane数据库中进行全面的文献搜索.
- 包括初级研究和元分析.
- 通过核心概念分类的数据的叙事综合.
主要成果:
- 预防性抗生素不会降低IPN的发病率或死亡率;保留确认/怀疑的IPN.
- 诊断可以依赖于临床怀疑或CT迹象,可能有助于生物标志物,如prokalcitonin.
- 早期启动抗生素是减少IPN相关死亡率的关键.
- 使用具有良好的胰腺透性的宽谱抗生素;避免常规抗真菌药物.
- 逐步升级的方法是标准的;根据源控制和患者状况,尽量减少抗生素的持续时间.
结论:
- 早期的抗生素治疗对于IPN治疗至关重要,但在AP中不建议预防性使用.
- 需要高质量的随机对照试验,以进一步定义抗生素和抗真菌在AP管理中的作用.
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