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著者: M G H Besselink, H C van Santvoort, E Buskens, M A Boermeester, H van Goor, H M Timmerman, V B Nieuwenhuijs, T L Bollen, B van Ramshorst, B J M Witteman, C Rosman, R J Ploeg, M A Brink, A F M Schaapherder, C H C Dejong, P J Wahab, C J H M van Laarhoven, E van der Harst, C H J van Eijck, M A Cuesta, L M A Akkermans, H G Gooszen, Acute Pancreatitis Werkgroep Nederland
雑誌名: Ned Tijdschr Geneeskd. 2008 Mar 22;152(12):685-96.
Abstract/Text
OBJECTIVE: To evaluate whether enteral prophylaxis with probiotics in patients with predicted severe acute pancreatitis prevents infectious complications.
DESIGN: Multicentre, randomised, double-blind, placebo-controlled trial.
METHOD: A total of 296 patients with predicted severe acute pancreatitis (APACHE II score > or = 8, Imrie score > or = 3 or C-reactive protein concentration > 150 mg/l) were included and randomised to one of two groups. Within 72 hours after symptom onset, patients received a multispecies preparation of probiotics or placebo given twice daily via a jejunal catheter for 28 days. The primary endpoint was the occurrence of one of the following infections during admission and go-day follow-up: infected pancreatic necrosis, bacteraemia, pneumonia, urosepsis or infected ascites. Secondary endpoints were mortality and adverse reactions. The study registration number is ISRCTN38327949.
RESULTS: Treatment groups were similar at baseline with regard to patient characteristics and disease severity. Infections occurred in 30% of patients in the probiotics group (46 of 152 patients) and 28% of those in the placebo group (41 of 144 patients; relative risk (RR): 1.1; 95% CI: 0.8-1.5). The mortality rate was 16% in the probiotics group (24 of 152 patients) and 6% (9 of 144 patients) in the placebo group (RR: 2.5; 95% CI: 1.2-5.3). In the probiotics group, 9 patients developed bowel ischaemia (of whom 8 patients died), compared with none in the placebo group (p = 0.004).
CONCLUSION: In patients with predicted severe acute pancreatitis, use of this combination of probiotic strains did not reduce the risk of infections. Probiotic prophylaxis was associated with a more than two-fold increase in mortality and should therefore not be administered in this category of patients.
PMID 18438065 Ned Tijdschr Geneeskd. 2008 Mar 22;152(12):685-96.
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