Heart：感染性心内膜炎的抗生素预防

2017-02-18 xing.T MedSci原创

由此可见，基于AP使用的证据较为有限，许多研究的异质性和方法学质量不佳。术后菌血症不是一个好的IE替代终点。考虑到一项随机试验逻辑上的挑战，高质量的病例-对照研究将有助于评估牙科手术再引起IE中的作用和AP的预防疗效。

预防性使用抗生素（AP）治疗来预防感染性心内膜炎（IE）存在争议。近年来，心脏病医生和牙科医生指南建议限制AP使用只允许高危人群使用（欧洲和美国）或对所有人都限制使用（在英国）。近日，在心脏病领域权威杂志Heart上发表了一篇荟萃分析文章，该荟萃分析旨在评价接受牙科治疗患者使用AP预防菌血症或IE的证据。

研究人员检索了MEDLINE、EMBASE、Cochrane图书馆和ISI Web of Science数据库，采用加强报告观察性研究流行病学标准和试验偏倚工具的Cochrane风险来评估纳入研究的方法学特征。两位评审者独立地确定研究的准入条件，评估纳入研究的方法，并提取数据。

研究人员确定了178个符合条件的研究，其中包括36篇综述。其中包括10个时间趋势研究，5个观察性研究和21个临床试验。所有确定的试验采用菌血症作为研究终点而不是IE，一个时间趋势研究表明全体AP限制可能与IE发病率不断上升相关，而相对AP限制的结果数据是相互矛盾的。对试验的荟萃分析表明AP可以有效降低菌血症的发生率（风险比为0.53，95%可信区间为0.49-0.57，P＜0.01），但病例对照研究表明对IE疾病低风险患者这可能不会产生显著的保护作用。

由此可见，基于AP使用的证据较为有限，许多研究的异质性和方法学质量不佳。术后菌血症不是一个好的IE替代终点。考虑到一项随机试验逻辑上的挑战，高质量的病例-对照研究将有助于评估牙科手术再引起IE中的作用和AP的预防疗效。

原始出处：

Thomas J Cahill,et al. Antibiotic prophylaxis for infective endocarditis: a systematic review and meta-analysis. Heart. 2017. http://heart.bmj.com/content/early/2017/02/17/heartjnl-2015-309102

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2017-09-20 12498974m61暂无昵称

#内膜#

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2017-10-20 charl1234575

#感染性#

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2017-02-20 zhaojie88

#心内膜炎#

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2017-02-20 zhaojie88

#ART#

29 0
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2017-02-20 slcumt

#HEART#

21 0
[GetPortalCommentsPageByObjectIdResponse(id=1708362, encodeId=59b01e08362eb, content=<a href='/topic/show?id=4c2d3051535' target=_blank style='color:#2F92EE;'>#内膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30515, encryptionId=4c2d3051535, topicName=内膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=730431558473, createdName=12498974m61暂无昵称, createdTime=Wed Sep 20 14:41:00 CST 2017, time=2017-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1655368, encodeId=9329165536894, content=<a href='/topic/show?id=7c2853311ac' target=_blank style='color:#2F92EE;'>#感染性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53311, encryptionId=7c2853311ac, topicName=感染性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=583d24724321, createdName=charl1234575, createdTime=Fri Oct 20 08:41:00 CST 2017, time=2017-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1350682, encodeId=95e1135068285, content=<a href='/topic/show?id=a32d508e8c3' target=_blank style='color:#2F92EE;'>#心内膜炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50878, encryptionId=a32d508e8c3, topicName=心内膜炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Feb 20 01:41:00 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356173, encodeId=aac913561e3e3, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Feb 20 01:41:00 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562439, encodeId=940c1562439fa, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Mon Feb 20 01:41:00 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176845, encodeId=66331e68459a, content=学习了，谢谢啦！, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Sat Feb 18 17:09:49 CST 2017, time=2017-02-18, status=1, ipAttribution=)]
2017-02-18 tanxingdoctor

学习了，谢谢啦！

50 0

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