Spontaneous bacterial peritonitis (SBP) in patients with cirrhotic liver disease is a serious complication that contributes to the high morbidity and mortality rate seen in this population. Currently, there is a lack ...Spontaneous bacterial peritonitis (SBP) in patients with cirrhotic liver disease is a serious complication that contributes to the high morbidity and mortality rate seen in this population. Currently, there is a lack of consensus amongst the research community on the clinical predictors of SBP as well as the risks and benefits of prophylactic antibiotic therapy in these patients. Pharmacological gastric acid suppression (namely with PPIs and H2RAs) are frequently prescribed for these patients, many times without a clear indication, and may contribute to gut bacterial overflow and SBP development. However, this remains controversial as there are conflicting findings in SBP prevalence between PPI/H2RA-users and non-users. In addition, studies show recent antibiotic use, whether for SBP prophylaxis or for another infectious process, appear to be associated with higher rates of SBP and drug-resistant organisms. Other researchers have also explored the link between zinc, platelet indices (MPV), and macrophage inflammatory protein-1 β (MIP-1β) levels in liver cirrhosis, all of which appear to be promising markers for classifying SBP risk and diagnosis. This literature review was limited by the number and quality of studies available as most are retrospective in nature. Thus, more ongoing, prospective studies and trials are needed to judge the true value of the findings in the studies reviewed in hopes that they can guide appropriate prevention, diagnosis, and management of SBP.展开更多
拯救败血症患者运动建议优先考虑使用质子泵抑制剂（PPI）预防应激性溃疡（SUP），而非组胺2受体拮抗剂（H2RA），但目前尚无研究证明在该人群中使用PPI更有优势。美国学者研究发现，对于需要机械通气的严重败血症和败血性休克患者，H2R...拯救败血症患者运动建议优先考虑使用质子泵抑制剂（PPI）预防应激性溃疡（SUP），而非组胺2受体拮抗剂（H2RA），但目前尚无研究证明在该人群中使用PPI更有优势。美国学者研究发现，对于需要机械通气的严重败血症和败血性休克患者，H2RA与胃肠（ GI）出血风险增加无关联。研究数据不支持拯救败血症患者运动关于将PPI作为该人群优先药物的建议。论文2014年6月在线发表于《药物治疗学年鉴》（ Ann Pharmacother ）。展开更多
The aim of this study was to determine the utilization of SRMD （stress related mucosal disease） prophylaxis in the ICU （intensive care unit） of a large teaching institution based on duration and defined adverse ef...The aim of this study was to determine the utilization of SRMD （stress related mucosal disease） prophylaxis in the ICU （intensive care unit） of a large teaching institution based on duration and defined adverse effects. Patients were reviewed for appropriateness of SRMD prophylactic therapy based on the presence of two independent risk factors （coagulopathy and mechanical ventilation greater than 48 hours） versus presence of any one risk factor from a list developed by the study investigator. Data was collected into spreadsheets and outcomes were analyzed using descriptive statistics. When evaluating patients based on the presence of any risk factor, 84 percent of patients had at least one risk factor present, while 16 percent did not have any. In patients who received famotidine, there was one occtLrrence of Clostridium difficile and 6 cases of electrolyte abnormalities. In patients who received a PPI, there was one documented case of HAP, two cases of ventilator-associated pneumonia, three cases of Clostridium difficile, and 14 patients who developed electrolyte abnormalities. Data does not show an association between acid suppression therapy and incidence of nosocomial infections. The number of patients whose therapy exceeded the appropriate stop-date compared with the number of patients in which SRMD prophylaxis was discontinued when risk factors diminished was greater when evaluating patients based upon the two independent risk factors.展开更多
文摘Spontaneous bacterial peritonitis (SBP) in patients with cirrhotic liver disease is a serious complication that contributes to the high morbidity and mortality rate seen in this population. Currently, there is a lack of consensus amongst the research community on the clinical predictors of SBP as well as the risks and benefits of prophylactic antibiotic therapy in these patients. Pharmacological gastric acid suppression (namely with PPIs and H2RAs) are frequently prescribed for these patients, many times without a clear indication, and may contribute to gut bacterial overflow and SBP development. However, this remains controversial as there are conflicting findings in SBP prevalence between PPI/H2RA-users and non-users. In addition, studies show recent antibiotic use, whether for SBP prophylaxis or for another infectious process, appear to be associated with higher rates of SBP and drug-resistant organisms. Other researchers have also explored the link between zinc, platelet indices (MPV), and macrophage inflammatory protein-1 β (MIP-1β) levels in liver cirrhosis, all of which appear to be promising markers for classifying SBP risk and diagnosis. This literature review was limited by the number and quality of studies available as most are retrospective in nature. Thus, more ongoing, prospective studies and trials are needed to judge the true value of the findings in the studies reviewed in hopes that they can guide appropriate prevention, diagnosis, and management of SBP.
文摘拯救败血症患者运动建议优先考虑使用质子泵抑制剂（PPI）预防应激性溃疡（SUP），而非组胺2受体拮抗剂（H2RA），但目前尚无研究证明在该人群中使用PPI更有优势。美国学者研究发现，对于需要机械通气的严重败血症和败血性休克患者，H2RA与胃肠（ GI）出血风险增加无关联。研究数据不支持拯救败血症患者运动关于将PPI作为该人群优先药物的建议。论文2014年6月在线发表于《药物治疗学年鉴》（ Ann Pharmacother ）。
文摘The aim of this study was to determine the utilization of SRMD （stress related mucosal disease） prophylaxis in the ICU （intensive care unit） of a large teaching institution based on duration and defined adverse effects. Patients were reviewed for appropriateness of SRMD prophylactic therapy based on the presence of two independent risk factors （coagulopathy and mechanical ventilation greater than 48 hours） versus presence of any one risk factor from a list developed by the study investigator. Data was collected into spreadsheets and outcomes were analyzed using descriptive statistics. When evaluating patients based on the presence of any risk factor, 84 percent of patients had at least one risk factor present, while 16 percent did not have any. In patients who received famotidine, there was one occtLrrence of Clostridium difficile and 6 cases of electrolyte abnormalities. In patients who received a PPI, there was one documented case of HAP, two cases of ventilator-associated pneumonia, three cases of Clostridium difficile, and 14 patients who developed electrolyte abnormalities. Data does not show an association between acid suppression therapy and incidence of nosocomial infections. The number of patients whose therapy exceeded the appropriate stop-date compared with the number of patients in which SRMD prophylaxis was discontinued when risk factors diminished was greater when evaluating patients based upon the two independent risk factors.
