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Infection rate among nutritional therapies for acute pancreatitis: A systematic review with network meta-analysis of randomized controlled trials
- Source :
- PLoS ONE, PLoS ONE, Vol 14, Iss 7, p e0219151 (2019)
- Publication Year :
- 2019
-
Abstract
- BackgroundInfection in acute pancreatitis (AP) is associated with nutritional therapies including naso-gastric (NG), naso-jejunal (NJ), and total parenteral nutrition (TPN). To examine infections among NG, NJ, TPN, and no nutritional support (NNS) in treating patients with AP.MethodsThe investigators completed comprehensive search in the Cochrane library, EMBASE, PubMed, Web of Science, and ClinicalTrials.gov without restriction on language and publication date before January 21, 2019. They also searched the reference lists of relevant studies for randomized controlled trials (RCTs) comparing NG, NJ, TPN, and NNS among patients with AP. Quantitative synthesis was conducted in a contrast-based network meta-analysis. To clarify effects, a network meta-analysis was conducted to calculate the surface under the cumulative ranking curve (SUCRA). Beside of overall infections, the event rates of infected pancreatic necrosis, bacteremia, line infection, pneumonia, urinary tract infection, and other types of infections were measured.ResultsThe network meta-analysis of 16 RCTs showed that NJ had significantly lower overall infection rates compared with TPN (risk ratio: 0.59; 95% confidence interval: 0.38, 0.90); and NG had a larger effect size and higher rank probability compared with NJ, TPN, and NNS (mean rank = 1.7; SUCRA = 75.8). TPN was the least preferred (mean rank = 3.2; SUCRA = 26.6).ConclusionsNG and NJ may be preferred therapies for treating patients with AP. Clinicians may consider NG as a first-line treatment for patients with AP (including severe AP) and even in patients receiving prophylactic antibiotics. In addition, we found that NNS should be avoided when treating patients with severe AP.
- Subjects :
- Network Meta-Analysis
Cochrane Library
Pathology and Laboratory Medicine
law.invention
0302 clinical medicine
Mathematical and Statistical Techniques
Randomized controlled trial
law
Antibiotics
Medicine and Health Sciences
Public and Occupational Health
030212 general & internal medicine
Antibiotic prophylaxis
Qualitative Research
Randomized Controlled Trials as Topic
Multidisciplinary
Antimicrobials
Statistics
Drugs
Metaanalysis
Research Assessment
Meta-analysis
Physical Sciences
Urinary Tract Infections
Medicine
Acute pancreatitis
030211 gastroenterology & hepatology
Parenteral Nutrition, Total
Nutrition Therapy
Research Article
medicine.medical_specialty
Systematic Reviews
Science
Urology
Gastroenterology and Hepatology
Research and Analysis Methods
Communicable Diseases
Microbiology
03 medical and health sciences
Necrosis
Signs and Symptoms
Diagnostic Medicine
Internal medicine
Microbial Control
medicine
Humans
Statistical Methods
Nutrition
Pharmacology
business.industry
Prophylaxis
Biology and Life Sciences
Antibiotic Prophylaxis
medicine.disease
Parenteral nutrition
Pancreatitis
Relative risk
Preventive Medicine
business
Mathematics
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 14
- Issue :
- 7
- Database :
- OpenAIRE
- Journal :
- PloS one
- Accession number :
- edsair.doi.dedup.....e6bfbdb2a34f95a22866fb1d4fcf3775