The Impact Of Antibiotic Prophylaxis In Severe Acute Pancreatitis:A Meta-Analysis

Objective:To investigate the impact of antibiotic prophylaxis on infected pancreatic necrosis and other adverse outcomes in severe acute pancreatitis.Methods:The "Cochrane Handbook for Systematic Reviews of Interventions version 6.0" was used as a methodological guide in this study.A systematic search of MEDLINE(PubMed),EMBASE,CENTRAL,Web of Science and other four Chinese databases was conducted to find randomized controlled trials(RCTs)on antibiotic prophylaxis in patients with severe acute pancreatitis.Pooled analyses were performed with Review Manager 5.3 software on the data associated with infected pancreatic necrosis,non-pancreatic infections,surgical interventions,all-cause death and fungal infections.Outcomes were expressed as the risk ratio(RR)and the 95%confidence interval(CI).Results:Total 12 RCTs involving 784 patients were included.There were 393 patients in the experimental group who received prophylactic antibiotics and 391 patients in the control group who received no prophylactic antibiotics.No significant differences between the experimental group and the control group were found with regard to infected pancreatic necrosis(RR=0.87,95%CI:0.65?1.17,P=0.36),non-pancreatic infections(RR=0.62,95%CI:0.38?1.02,P=0.06),surgicalinterventions(RR=1.1,95%CI:0.83?1.46,P=0.51),all-cause death(RR=0.88,95%CI:0.61?1.27,P=0.51)and fungal infections(RR=0.55,95%CI:0.24?1.26,P=0.16).Conclusion:Antibiotic prophylaxis didn't significantly affect the risk of infected pancreatic necrosis,non-pancreatic infections,surgical interventions,all-cause death or fungal infections in patients with severe acute pancreatitis.