Effect of Perioperative Probiotics and Synbiotics on Postoperative Infections After Gastrointestinal Surgery: A Systematic Review With Meta-Analysis
Effect of Perioperative Probiotics and Synbiotics on Postoperative Infections After Gastrointestinal Surgery: A Systematic Review With Meta-Analysis
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围手术期益生菌和合生元对胃肠手术后感染的影响：系统评价与荟萃分析
DOI：
10.1177/0148607116629670
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发表时间：
2017
影响因子：
3.4
通讯作者：
D. Fan
中科院分区：
文献类型：
--
作者：
Zhiping Yang;Qiong Wu;Yunfang Liu;D. Fan
背景：胃肠道手术后细菌感染仍然是一种常见的疾病。本研究的目的是评估围手术期使用益生菌和合生元对术后感染的影响。材料和方法：我们检索了PubMed、Embase和科克伦图书馆，以确定相关的随机对照试验（RCT）。主要结局是术后感染率。次要结局是住院和重症监护室（ICU）住院时间、抗生素治疗时间和死亡率。使用随机效应模型计算汇总结果。结果：28项随机对照试验纳入2511例患者。接受益生菌/合生元治疗的患者感染并发症的发生率低于对照组（比值比[OR] = 0.35; 95%置信区间[CI]，0.24-0.50），特别是关于呼吸道（OR = 0.44; 95%CI，0.28-0.68）、泌尿道（OR = 0.30; 95%CI，0.16-0.55）和伤口感染（OR = 0.58; 95%CI，0.42-0.80）。接受益生菌/合生元治疗的患者的住院时间（平均差异[MD] =-3.20; 95%CI，-4.87至-1.54）和抗生素治疗时间（MD =-3.40; 95%CI，-4.67至-2.13）均短于对照组。两组间死亡率（OR = 1.19; 95%CI，0.52-2.74）或ICU住院时间（MD =-0.46; 95%CI，-1.07至0.14）无显著差异。结论：益生菌和合生元可预防胃肠道手术后感染。然而，由于纳入研究存在偏倚风险和潜在的出版偏倚，因此需要谨慎解释结果。
Background: Bacterial infection following gastrointestinal surgery remains a common morbidity. The aim of this study was to estimate the effect of the perioperative use of probiotics and synbiotics on postoperative infections. Materials and Methods: We searched PubMed, Embase, and the Cochrane Library to identify pertinent randomized controlled trials (RCTs). The primary outcome was postoperative infection rate. The secondary outcomes were length of hospital and intensive care unit (ICU) stay, length of antibiotic therapy, and mortality. The pooled outcomes were calculated using random effects models. Results: Twenty-eight RCTs involving 2511 patients were included in this systematic review. The incidence of infectious complications was lower among patients who received probiotics/synbiotics than among the controls (odds ratio [OR] = 0.35; 95% confidence interval [CI], 0.24–0.50), particularly regarding respiratory (OR = 0.44; 95% CI, 0.28–0.68), urinary tract (OR = 0.30; 95% CI, 0.16–0.55), and wound infections (OR = 0.58; 95% CI, 0.42–0.80). The lengths of hospital stay (mean difference [MD] = −3.20; 95% CI, −4.87 to −1.54) and duration of antibiotic therapy (MD = −3.40; 95% CI, −4.67 to −2.13) were shorter for patients who received probiotics/synbiotics than for controls. There were no significant differences in mortality (OR = 1.19; 95% CI, 0.52–2.74) or length of ICU stay (MD = −0.46; 95% CI, −1.07 to 0.14) between the compared groups. Conclusion: Probiotics and synbiotics may prevent postoperative infections in patients undergoing gastrointestinal surgery. However, the results need to be interpreted with caution due to the risk of bias in the included studies and the potential publication bias.