预防性抗生素用于肝硬化患者上胃肠道出血:系统性审查和贝叶斯元分析
Connor Prosty1,2, Dean Noutsios1, Laurie-Rose Dubé1
1Faculty of Medicine, McGill University, Montréal, Québec, Canada.
目前的指导方针推57天的抗生素预防肝硬化与胃肠道出血,但证据很弱. 较短的持续时间显示死亡率和再出血的非劣势,尽管感染率较高. 需要更多的研究.
科学领域:
- 胃肠病学 胃肠病学
- 传染性疾病 传染性疾病
- 临床药理学 临床药理学
背景情况:
- 国际指导方针建议,对于肝硬化和上部胃肠道出血的患者,进行5~7天的抗生素预防.
- 支持这一建议的证据需要最近重新评估.
研究的目的:
- 评估当前的证据是否支持对肝硬化患者经历上部胃肠道出血的确定的57天抗生素预防持续时间.
主要方法:
- 在Embase,MEDLINE和CENTRAL数据库的系统搜索中,确定了截至2024年9月25日的随机临床试验 (RCT).
- 使用贝叶斯元分析,对2004年以后发表的研究进行子组分析,以解释治疗进展.
主要成果:
- 对14个RCT (1322名参与者) 的分析表明,较短的抗生素持续时间 (23天或没有) 对所有原因的死亡率具有97.3%的非劣势概率.
- 虽然较短的持续时间与细菌感染的增加有关,但在2004年后发表的研究中,它们对死亡率和再出血的非劣势概率更高.
结论:
- 目前的证据并不能强烈支持支持该患者群体抗生素预防的指导方针建议的死亡率益处.
- 方法上的局限性,特别是在定义感染时,引入了偏见;为了确定最佳的预防持续时间,需要更高质量的RCT.
- 临床医生应该认识到,目前的指南缺乏强有力的证据,需要谨慎应用.
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