预防性抗生素在怀疑胆道阻塞的患者中减少ERCP后的感染并发症:随机对照试验的元分析
Toni Habib1, Chloe Lahoud1, Elie Moussa1
1Department of Internal Medicine, Staten Island University Hospital, Northwell Health, 475 Seaview Avenue, Staten Island, NY, USA.
Digestive diseases and sciences
|October 24, 2025
概括
预防性抗生素显著降低了胆道阻塞患者的ERCP后感染. 这些发现挑战了当前的指导方针,表明手术前的抗生素可以改善结果,特别是在有放射性阻塞证据的情况下.
科学领域:
- 胃肠病学 胃肠病学
- 传染性疾病 传染性疾病
- 临床试验 临床试验
背景情况:
- 在ERCP之前预防性抗生素的使用是有争议的,目前的指导方针建议不要常规使用.
- 本元分析研究了预防性抗生素在疑似胆道阻塞的ERCP期间预防感染并发症的疗效.
研究的目的:
- 评估预防性抗生素在ERCP后减少感染并发症中的作用.
- 评估抗生素对胆管炎,细菌病和整体感染率的影响.
主要方法:
- 随机对照试验 (RCT) 的系统审查和元分析.
- 包括的研究比较了抗生素与安慰剂在接受ERCP怀疑胆道阻塞的患者.
- 搜索CENTRAL,MEDLINE和EMBASE数据库至2025年1月;不包括只有摘要的出版物.
主要成果:
- 分析了5个带有1,154名患者的RCT,570人接受了抗生素,584人接受了安慰剂.
- 预防性抗生素显著减少了胆管炎 (RR 0.44),细菌病 (RR 0.28) 和传染性并发症 (RR 0.35).
- 特别是在放射学证据表明胆道阻塞的患者中观察到益处.
结论:
- 术前预防性抗生素显著降低了胆道阻塞患者的ERCP后感染.
- 这些发现挑战了现有的指导方针,主张考虑使用抗生素,特别是在放射学证实阻塞的情况下.
- 进一步的RCT是有必要的,但目前的证据支持使用预防性抗生素来提高患者的治疗结果.
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