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A unique feature of Epistemonikos is that it connects systematic reviews and their included studies. This allows clustering systematic reviews based on the primary studies they have in common. The concept of 'systematic reviews sharing included studies' is a proxy of 'systematic reviews answering a similar question'.

A matrix of evidence is a tabular way of displaying the cluster of systematic reviews that share included studies, and all the studies included in these reviews. It is automatically created based on the connections of the database, and can be trimmed by the user in order to reflect an accurate body of evidence for a specific question.

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33 References (25 Primary studies) Studify 90.9%Randomized controlled trial (RCT)30 / 33
Barreda L2009Delcenserie R1996Dellinger EP2007Finch WT1976García-Barrasa ..2009Howes R1975Isenmann R2004Luiten EJ1995Nordback I2001Pederzoli P1993Røkke O2007Sainio V1995Schwarz M1997Spicak J2003Spicak J2002Spicak J2004Spicak JHS2003Xue P2009Yang XN2009Ignatavicius P2012Ho HS1997Poropat G2015Bassi C1992Hejtmankova S2003Isenmann R2003Hubaczová M2000Sainio V1994Poropat G2017Poropat, Goran2016Poropat G2019Nakaharai K2018Qu R2012Manes G2006
23 Systematic reviews
Wittau M2011Jiang K2012Dambrauskas Z2007Yao L2010Bai Y2010Golub R1999Xu T2008Jafri NS2009Hart PA2008Villatoro E2010Bai Y2008de Vries AC2007Xiong GS2006Mazaki T2006饶春燕(Rao CY)2012Sharma VK2001Ukai T2015Lim CL2015Moggia E2017Ding N2020Guo D2022Poropat G2022Büyükkörük M2023
10 References ( articles) loading Revert Studify

Primary study

Unclassified

Timing of antibiotic prophylaxis in acute pancreatitis: a controlled randomized study with meropenem.

Journal The American journal of gastroenterology
Year 2006
Links Pubmed DOI
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OBJECTIVES: Antibiotic prophylaxis improves the outcome of acute pancreatitis. Since bacterial translocation from the gut occurs in the first h of disease, early therapy is likely to achieve the maximal effect. The study compares early antibiotic treatment with treatment started after the demonstration of pancreatic necrosis. METHODS: Two hundred fifteen patients with pancreatitis were randomized to either group A (N=108), who started antibiotic therapy (meropenem 500 mg t.i.d.) at admission, or group B (N=107), who received antibiotics after the demonstration of necrosis at computed tomography (CT). CT was performed in both groups after at least 48 hr of hospitalization. The clinical course of disease was compared in the two groups. RESULTS: Thirty patients in group A and 29 in B showed necrosis on CT. The two groups were similar in demographics and characteristics of disease. Antibiotic treatment was started after 4.56+/-1.2 days from hospitalization in group B and after 1.07+/-0.6 days in A. Pancreatic infection occurred in four patients in group A (13.3%) and in nine in B (31%) (p=0.1). Extrapancreatic infection occurred in 16.6% of patients in group A and in 44.8% in B (p<0.05). Need for surgery and length of hospitalization were also higher in group B. Mortality rates were similar in the two groups, but, 3 of 4 patients with infected necrosis in group A and only 2 of 9 in group B died. CONCLUSIONS: Early antibiotic treatment is associated with a significant improvement in the prognosis of necrotizing acute pancreatitis (AP), because of a reduction in the occurrence of septic complications.

Systematic review

Unclassified

The Effect of Prophylactic Carbapenem Use on Outcomes in Acute Pancreatitis: A Systematic Review and Meta-Analysis.

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Journal Infectious diseases & clinical microbiology
Year 2023
Links Pubmed DOI PubMed Central
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OBJECTIVE: This study aimed to determine the effect of prophylactic use of carbapenems for acute pancreatitis on clinical outcomes. MATERIALS AND METHODS: It was conducted according to the preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using the keywords "Pancrea * AND carbapenem OR imipenem OR ertapenem OR meropenem OR doripenem." Primer outcomes were mortality, surgical intervention, and pancreatic and non-pancreatic infection. Subgroup analyses were also performed to reduce the risk of bias. RESULTS: Ten studies with 4038 patients were included in the meta-analyses. While eight of ten were randomized controlled trials, two were observational studies. The prophylactic use of carbapenems had no statistically significant effect on mortality (OR=0.82, 95% CI=0.65-1.04, I²=0%) and surgical intervention. (OR=0.81, 95% CI=0.57-1.17, I²=0%). However, the real impact of prophylaxis on reducing the incidence of mortality and surgical intervention was uncertain due to the insufficient sample size. The prophylactic use of carbapenems was significantly associated with a lower risk of peripancreatic (OR=0.37, 95% CI=0.25-0.55, I²=61%) and non-pancreatic infection risk (OR=0.60, 95% CI=0.46-0.78, I²=65%). The definitions of infection in the articles were not clear, and the diagnostic approach to infection was based on subjective criteria. In addition, there was inadequate collateral damage and safety assessments. In high-quality studies with a low risk of bias, prophylactic carbapenems had no effect on peripancreatic infection (RR=1.54, 95% CI=0.65-3.47, I²=0%) and non-pancreatic infection (RR=0.72, 95% CI=0.48-1.07, I²=0%). CONCLUSION: Although there is a reduction in the infection risk, routine carbapenem use in acute pancreatitis cases should not be recommended based on current evidence. Cooperation with Infectious Disease specialists and developing diagnostic algorithms are required instead of routine prophylaxis to prevent infection, especially non-pancreatic infection.

Primary study

Unclassified

Procalcitonin is a good tool to guide duration of antibiotic therapy in patients with severe acute pancreatitis. A randomized prospective single-center controlled trial.

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Authors Qu R , Ji Y , Ling Y , Ye CY , Yang SM , Liu YY , Yang RY , Luo YF , Guo Z
Journal Saudi medical journal
Year 2012
Links Pubmed
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OBJECTIVE: To investigate the clinical usefulness of procalcitonin (PCT) for guiding duration of antibiotic therapy in patients with severe acute pancreatitis (SAP). METHODS: A total of 71 patients with confirmed severe acute pancreatitis from March 2009 to September 2011 in the Department of Critical Care Medicine of Huizhou Municipal Central Hospital, Guangdong, China were enrolled in this study. Procalcitonin was measured daily by a semi-quantitative immunoassay in the study group. Patients were randomly assigned into 2 groups including a PCT-guided group (study group) and a prophylactic antibiotic therapy (control group). Antibiotic therapy in the study group was not applied until clinical signs and symptoms of infection appeared (PCT value was >0.5ng/ml). We discontinued the antibiotic therapy if clinical signs and symptoms of infection improved and PCT was <0.5ng/ml over 3 days. In the control group, antibiotic therapy was administrated for 2 weeks, or antibiotic therapy was continued because of confirmed infection until clinical signs and symptoms of infection disappeared over 3 days. RESULTS: In the study group (35 patients), the duration of antibiotic therapy and hospitalization was significantly shorter than the control group (36 patients) (10.89+/-2.85 versus 16.06+/-2.48 days, p<0.001, and 16.66+/-4.02 days versus 23.81+/-7.56 days, p<0.001) without negative clinical effects and the cost of hospitalization was significantly lower. CONCLUSION: Procalcitonin is a helpful and safe tool for guiding duration of antibiotic treatment in patients with severe acute pancreatitis.

Systematic review

Unclassified

Systematic Review with Trial Sequential Analysis of Prophylactic Antibiotics for Acute Pancreatitis

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Journal Antibiotics (Basel, Switzerland)
Year 2022
Links Pubmed DOI PubMed Central
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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.

Primary study

Unclassified

Early prophylactic antibiotics for severe acute pancreatitis: A population-based cohort study using a nationwide database in Japan.

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Journal Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
Year 2018
Links Pubmed DOI
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OBJECTIVES: Previous studies evaluating the clinical benefits of prophylactic antibiotics for severe acute pancreatitis (SAP) have generated inconsistent results due to heterogeneities among the study settings. We determined if early prophylactic antibiotics improved the outcomes of SAP patients using a study designed to overcome these previous methodological weaknesses. METHODS: We conducted a retrospective cohort study of SAP patients discharged between July 2010 and March 2016, using a Japanese nationwide inpatient database. We divided patients into those with early prophylactic carbapenem use (prophylaxis group) and those without prophylaxis (control group). The primary outcome was in-hospital mortality and the secondary outcomes included oral vancomycin use and others. RESULTS: We identified a total of 3354 eligible patients, including 2493 in the prophylaxis group and 861 in the control group. The overall in-hospital mortality was 12.8%. Prophylactic antibiotics were not significantly associated reduced in-hospital mortality according to Cox regression analysis (hazard ratio (HR), 0.88; 95% confidence interval (CI), 0.62-1.23) or instrumental variable analysis (risk difference, -1.2%; 95% CI, -9.8%-7.4%). However, prophylactic antibiotic use was significantly associated with oral vancomycin use during hospitalization in a competing-risk model (subdistribution HR, 1.91; 95% CI, 1.02-3.56). CONCLUSIONS: The present study suggests that routine early prophylactic antibiotic use have no significant clinical benefit in SAP patients but may increase the risk of hospital-acquired infections.

Primary study

Unclassified

Prevention of Infectious Complications in Acute Pancreatitis: Results of a Single-Center, Randomized, Controlled Trial.

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Journal Pancreas
Year 2019
Links Pubmed DOI
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OBJECTIVES: This study aimed to investigate the efficiency of imipenem to prevent infectious complications in predicted severe acute pancreatitis (AP). METHODS: Consecutive AP patients were randomized to imipenem 3 × 500 mg intravenously daily or an identical placebo. Exclusion criteria were prior AP, chronic pancreatitis, active malignancy, immune deficiency, active infection, concomitant antibiotic treatment, pregnancy, and patients younger than 18 years. Infectious complications including infected pancreatic necrosis, pneumonia, urinary tract infection, positive blood cultures, sepsis, and other infections were assessed as the primary outcome. Secondary outcomes included mortality, persistent organ failure, systemic inflammatory response syndrome, local complications, serious adverse events, and need for surgical intervention. RESULTS: Forty-nine patients were randomized to each group. Infectious complications were present in 10 versus 12 of 49 patients (relative risk [RR], 0.833; 95% confidence interval [CI], 0.398-1.747). There were no significant differences in infected pancreatic necrosis (RR, 1.5; 95% CI, 0.262-8.588), pneumonia (RR, 1.5; 95% CI, 0.262-8.588), urinary tract infection (RR, 0.6; 95% CI, 0.152-2.374), positive blood cultures (RR, 0.5; 95% CI, 0.047-5.336), sepsis (RR, 0.333; 95% CI, 0.036-3.095), and other (RR, 1.333; 95% CI, 0.315-5.648). We found no significant differences in secondary outcomes. CONCLUSIONS: Concordantly to available evidence, there is currently no ground to support prophylactic use of antibiotics in predicted severe AP.

Systematic review

Unclassified

Assessment of Prophylactic Carbapenem Antibiotics Administration for Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis.

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Authors Guo D , Dai W , Shen J , Zhang M , Shi Y , Jiang K , Guo L
Journal Digestion
Year 2022
Links Pubmed DOI
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BACKGROUND: The effectiveness of prophylactic antibiotics in severe acute pancreatitis (SAP) remains a debatable issue. This meta-analysis aimed to determine the efficacy of prophylactic carbapenem antibiotics in SAP. METHODS: This meta-analysis of prophylactic carbapenem antibiotics for SAP was conducted in PubMed, EMBASE, Web of Science, MEDLINE, and Cochrane Library up to February 2021. The related bibliographies were manually searched. The primary outcomes involved infected pancreatic or peripancreatic necrosis, mortality, complications, infections, and organ failure. RESULTS: Seven articles comprised 5 randomized controlled trials and 2 retrospective observational studies, including 3,864 SAP participants. Prophylactic carbapenem antibiotics in SAP were associated with a statistically significant reduction in the incidence of infections (odds ratio [OR]: 0.27; p = 0.03) and complications (OR: 0.48; p = 0.009). Nevertheless, no statistically significant difference was demonstrated in the incidence of infected pancreatic or peripancreatic necrosis (OR: 0.74; p = 0.24), mortality (OR: 0.69; p = 0.17), extrapancreatic infection (OR: 0.64, p = 0.54), pulmonary infection (OR: 1.23; p = 0.69), blood infection (OR: 0.60; p = 0.35), urinary tract infection (OR: 0.97; p = 0.97), pancreatic pseudocyst (OR: 0.59; p = 0.28), fluid collection (OR: 0.91; p = 0.76), organ failure (OR: 0.63; p = 0.19), acute respiratory distress syndrome (OR: 0.80; p = 0.61), surgical intervention (OR: 0.97; p = 0.93), dialysis (OR: 2.34; p = 0.57), use of respirator or ventilator (OR: 1.90; p = 0.40), intensive care unit treatment (OR: 2.97; p = 0.18), and additional antibiotics (OR: 0.59; p = 0.28) between the experimental and control groups. CONCLUSIONS: It is not recommended to administer routine prophylactic carbapenem antibiotics in SAP.

Primary study

Unclassified

Imipenem prophylaxis for predicted severe acute pancreatitis – Preliminary results of a randomized clinical trial

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Conference Abstracts of the EPC meeting 2016
Year 2016
Links DOI
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Primary study

Unclassified

Prevention of infectious complications in predicted severe acute pancreatitis (SAP)-a single center randomized controlled trial

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Conference Published in: Pancreatology
Year 2017
Links DOI
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INTRODUCTION: It's mostly accepted there's no need for routine antibiotic prophylaxis in mild cases of AP. Evidence of prevention of infectious complications in SAP is still controversial with imipenem showing potential benefit. Aims: To investigate prophylactic use of imipenem for prevention of infectious complications in predicted SAP. PATIENTS & METHODS: Consecutive AP patients with APACHE II 8 were randomly assigned in a double-blind manner to receive imipenem 3x500 mg i.v. daily or an identical placebo ideally for ten days. Infectious complications including infected pancreatic necrosis, pneumonia, urinary tract infection (UTI), positive blood cultures, sepsis, and other infections were determined as the primary outcome. Exclusion criteria were prior AP, chronic pancreatitis, active malignancy, immune deficiency, active infection, concomitant antibiotic treatment within 72 hours before enrollment, pregnant and breasfeeding women, and patients <18 years. Concomitant treatment was given equally in both groups. RESULTS: A total of 98 patients were randomized, 49 to each group. Patients were similar according to demographics and average disease severity scores. Infective complications were present in 10/49 versus 12/49 patients (P¼0, 81). There was no significant difference in specific infective complications: infective pancreatic necrosis (3/49 vs. 2/49), pneumonia (3/ 49 vs. 2/49), UTI (3/49 vs. 5/49), positive blood cultures (1/49 vs. 3/49), sepsis (1/49 vs. 2/49), and other (4/49 vs. 3/49), respectively. We found no significant differences in mortality (P¼1, 00), organ failure (P¼0, 39), and local complications (P¼0, 31). Occurrence of mycotic infections was similar in both groups. CONCLUSION: Our results add to available evidence there's currently no ground to support routine prophylactic use of antibiotics in pedicted SAP.

Systematic review

Unclassified

Assessment of prophylactic antibiotics administration for acute pancreatitis: a meta-analysis of randomized controlled trials.

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Authors Ding N , Sun YH , Wen LM , Wang JH , Yang JH , Cheng K , Lin H , Chen QL
Journal Chinese medical journal
Year 2020
Links Pubmed DOI PubMed Central
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BACKGROUND: Recent evidence has shown that prophylactic antibiotic treatment in patients with acute pancreatitis is not associated with a significant decrease in mortality or morbidity. The use and efficacy of prophylactic antibiotic treatment in acute pancreatitis remain controversial. This meta-analysis was conducted to assess whether antibiotic prophylaxis is beneficial in patients with acute pancreatitis. METHODS: We searched randomized controlled trials (RCTs) of prophylactic use of antibiotics using Medline (PubMed), Embase, the Cochrane Library, and Web of Science. The data were analyzed using Review Manager 5.3 software. We performed pooled analyses for infected pancreatic necrosis, mortality, surgical intervention, and non-pancreatic infection. Odds ratios (ORs) from each trial were pooled using a random or fixed effects model, depending on the heterogeneity of the included studies. Sub-group analysis or sensitivity analysis was conducted to explore potential sources of heterogeneity, when necessary. RESULTS: Totally, 11 RCTs involving 747 participants were included, with an intervention group (prophylactic use of antibiotics, n = 376) and control group (n = 371). No significant differences were found regarding antibiotic prophylaxis with respect to incidence of infected pancreatic necrosis (OR, 0.74; 95% confidence interval [CI], 0.50-1.09; P = 0.13), surgical intervention (OR, 0.92; 95% CI, 0.62-1.38; P = 0.70), and morality (OR, 0.71; 95% CI, 0.44-1.15; P = 0.16). However, antibiotic prophylaxis was associated with a statistically significant reduction in the incidence of non-pancreatic infection (OR, 0.59; 95% CI, 0.42-0.84; P = 0.004). CONCLUSIONS: Prophylactic antibiotics can reduce the incidence of non-pancreatic infection in patients with AP.
References ( articles) loading Revert Studify
References ( articles) loading Revert Studify