SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Philippe SEKSIK
Coup de coeur :
 
 
Alimentary Pharmacology & Therapeutics (APT)
  2016/01  
 
  2016 Jan;43(1):52-60  
  doi: 10.1111/apt.13454. Epub 2015 Nov 5  
 
  Adjuvant use of antibiotics with corticosteroids in inflammatory bowel disease exacerbations requiring hospitalisation: a retrospective cohort study and meta-analysis  
 
  Gupta V, Rodrigues R, Nguyen D, Sauk J, Khalili H, Yajnik V, Ananthakrishnan AN  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Adjuvant+use+of+antibiotics+with+corticosteroids+in+in%EF%AC%82ammatory+bowel+disease+exacerbations+requiring+hospitalisation%3A+a+retrospective+cohort+study+and+meta-analysis  
 
 

BACKGROUND: Patients hospitalised with an exacerbation of inflammatory bowel disease (IBD) often receive antibiotics in addition to intravenous steroids. However, their efficacy in this setting is unclear.

AIM: To ascertain if the addition of antibiotics to intravenous steroids modifies short and long-term clinical outcomes.

METHODS: Our study included IBD patients hospitalised between 2009 and 2014 who received intravenous (IV) steroids with or without adjuvant antibiotics. Outcomes of interest included length of stay (LOS), need for medical and surgical rescue therapy during the hospitalisation, and at 90 and 365 days. A meta-analysis of previously published randomised trials was additionally performed.

RESULTS: A total of 354 patients were included [145 ulcerative colitis (UC); 209 Crohn's disease (CD)]. In CD, combination of IV steroids and antibiotics did not change need for in-hospital medical rescue therapy, surgery or hospitalisations at 1 year but was associated with greater LOS (6.1 vs. 4.6 days, P = 0.02). In UC, patients receiving antibiotics were less likely to require in-hospital medical rescue therapy [odds ratio (OR): 0.42, 95% confidence interval (CI): 0.19-0.93] but experienced no statistically significant differences in LOS, in-hospital surgery, re-hospitalisations or surgery by 1 year. A meta-analysis of three relevant randomised trials demonstrated no difference in clinical improvement with antibiotics over placebo (OR: 1.08, 95% CI: 0.50-2.32).

CONCLUSIONS: The addition of antibiotics to intravenous steroids for treatment of IBD exacerbations was associated with a reduced need for in-hospital medical rescue therapy in ulcerative colitis without significant long-term benefit, and did not affect short- or long-term outcomes in Crohn's disease.

 
Question posée
 
Y a-t- il un bénéfice à ajouter une antibiothérapie chez des patients hospitalisés pour une MICI et recevant des corticoïdes ?
 
Question posée
 
Non
 
Commentaires

Il s’agit d’une double étude puisque ce papier livre une étude de cohorte et une méta-analyse pour tenter de répondre à cette question. L’étude de cohorte a le mérite d’être analysée en utilisant un score de propention (ajustement sur la probabilité à recevoir une antibiothérapie) ce qui limite certains biais. La méta analyse ne retient que trois essais (n=133 cas). L’ensemble conduit à ne pas recommander l’utilisation d’antibiotique chez les patients hospitalisés pour poussées et devant recevoir une corticothérapie. Cette situation est assez fréquente en pratique clinique et le message est donc important. L’émergence des infections à Clostridium difficile, l’impact d’une antibiothérapie sur le développement des antibio-résistances et sur de déséquilibre du microbiote sont autant d’éléments qui vont dans le sens de l’absence de recours systématique aux antibiotiques dans cette situation.

 
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