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Poropat G, Goričanec K, Lacković A, Kresović A, Lončarić A, Marušić M. Systematic Review with Trial Sequential Analysis of Prophylactic Antibiotics for Acute Pancreatitis. Antibiotics (Basel) 2022; 11:antibiotics11091191. [PMID: 36139970 PMCID: PMC9495153 DOI: 10.3390/antibiotics11091191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/OBJECTIVES Prophylactic antibiotics (PAB) are being still widely used for treatment of acute pancreatitis (AP) despite trials showing no firm evidence of efficacy. We aimed to evaluate effects of PAB for AP in a meta-analysis and the need for further research by trial sequential analysis (TSA). METHODS Medline, Scopus and Web of Science were searched for randomized clinical trials. Primary outcomes were all infections and mortality. Secondary outcomes comprised infected pancreatic necrosis (IPN), specific infections, organ failure, surgical interventions, and length of hospital stay. RESULTS Twenty-one trials with 1383 pts were included. PAB were received by 703 pts, while 680 were controls. Mortality was similar with RR 0.85 (95% CI 0.66-1.10). Infections were significantly reduced (RR 0.60; 95% CI 0.49-0.74), mainly due to decreased risk of sepsis (RR 0.43; 95% CI 0.25-0.73) and urinary tract infections (RR 0.46; 95% CI 0.25-0.86). No significant reduction for IPN was shown (RR 0.81; 95% CI 0.63-1.04). Length of hospital stay was diminished by MD -6.65 (95% CI -8.86 to -4.43) days. TSA for all infections showed that the cumulative Z score crossed both conventional and monitoring boundaries at 526 pts from a heterogeneity-corrected required information size of 1113 pts based on a 40% incidence of infections in the control group, RRR of 30%, alpha 5%, beta 20%, and heterogeneity 56%. CONCLUSIONS PABs decrease the rate of infections in AP, mainly due to RRR of extra-pancreatic infections, requiring no further research. No significant effect is shown on IPN and mortality, although firmer evidence is needed.
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Affiliation(s)
- Goran Poropat
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Correspondence:
| | - Karla Goričanec
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Alojzije Lacković
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Andrea Kresović
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Antun Lončarić
- Department of Cardiology, General Hospital ‘‘Dr. Ivo Pedisic’’ Sisak, 44000 Sisak, Croatia
| | - Martina Marušić
- Department of Emergency Medicine, General Hospital Zadar, 23000 Zadar, Croatia
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Papanikolaou IS, Tziatzios G, Chatzidakis A, Facciorusso A, Crinò SF, Gkolfakis P, Deriban G, Tadic M, Hauser G, Vezakis A, Jovanovic I, Muscatiello N, Meneghetti A, Miltiadou K, Stardelova K, Lacković A, Bourou MZ, Djuranovic S, Triantafyllou K. COVID-19 in the endoscopy unit: How likely is transmission of infection? Results from an international, multicenter study. World J Gastrointest Endosc 2021; 13:416-425. [PMID: 34630891 PMCID: PMC8474700 DOI: 10.4253/wjge.v13.i9.416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) significantly affected endoscopy practice, as gastrointestinal endoscopy is considered a risky procedure for transmission of infection to patients and personnel of endoscopy units (PEU).
AIM To assess the impact of COVID-19 on endoscopy during the first European lockdown (March-May 2020).
METHODS Patients undergoing endoscopy in nine endoscopy units across six European countries during the period of the first European lockdown for COVID-19 (March-May 2020) were included. Prior to the endoscopy procedure, participants were stratified as low- or high- risk for potential COVID-19 infection according to the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) joint statement, and contacted 7-14 d later to assess COVID-19 infection status. PEU were questioned regarding COVID-19 symptoms and/or infection via questionnaire, while information regarding hospitalizations, intensive care unit-admissions and COVID-19-related deaths were collected. The number of weekly endoscopies at each center during the lockdown period was also recorded.
RESULTS A total of 1267 endoscopies were performed in 1222 individuals across nine European endoscopy departments in six countries. Eighty-seven (7%) were excluded because of initial positive testing. Of the 1135 pre-endoscopy low risk or polymerase chain reaction negative for COVID-19, 254 (22.4%) were tested post endoscopy and 8 were eventually found positive, resulting in an infection rate of 0.7% [(95%CI: 0.2-0.12]. The majority (6 of the 8 patients, 75%) had undergone esophagogastroduodenoscopy. Of the 163 PEU, 5 [3%; (95%CI: 0.4-5.7)] tested positive during the study period. A decrease of 68.7% (95%CI: 64.8-72.7) in the number of weekly endoscopies was recorded in all centers after March 2020. All centers implemented appropriate personal protective measures (PPM) from the initial phases of the lockdown.
CONCLUSION COVID-19 transmission in endoscopy units is highly unlikely in a lockdown setting, provided endoscopies are restricted to emergency cases and PPM are implemented.
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Affiliation(s)
- Ioannis S Papanikolaou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Alexandros Chatzidakis
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia AOU, Foggia 1245, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Verona 37138, Italy
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels 1070, Belgium
- Department of Medical Oncology, Institut Jules Bordet, Brussels 1000, Belgium
| | - Gjorgi Deriban
- University Clinic of Gastroenterohepatology, Medical Faculty, University "Ss. Cyril and Methodius" Skopje, Skopje 12345, Republic of North Macedonia
| | - Mario Tadic
- Department of Gastroenterology, Dubrava University Hospital Zagreb, Zagreb 10040, Croatia
| | - Goran Hauser
- Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Antonios Vezakis
- 2nd Department of Surgery, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Ivan Jovanovic
- Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, University of Belgrade Faculty of Medicine, Beograd 12345, Serbia
| | - Nicola Muscatiello
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia AOU, Foggia 1245, Italy
| | - Anna Meneghetti
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Verona 37138, Italy
| | - Konstantinos Miltiadou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Kalina Stardelova
- University Clinic of Gastroenterohepatology, Medical Faculty, University "Ss. Cyril and Methodius" Skopje, Skopje 12345, Republic of North Macedonia
| | - Alojzije Lacković
- Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Maria-Zoi Bourou
- 2nd Department of Surgery, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Srdjan Djuranovic
- Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, University of Belgrade Faculty of Medicine, Beograd 12345, Serbia
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
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