{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T08:59:55Z","timestamp":1769504395576,"version":"3.49.0"},"reference-count":35,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,6,22]],"date-time":"2024-06-22T00:00:00Z","timestamp":1719014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>The benefits of prophylactic antibiotics in patients with alcohol\u2010associated hepatitis (AH) receiving steroids remain unclear. We aimed to assess the clinical impact of prophylactic antibiotics in AH patients receiving steroids.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We systematically reviewed four electronic databases from inception to 30 November 2023. Pooled estimates were analysed using random\u2010effects models. The primary outcome was 90\u2010day survival. Secondary outcomes included infection at days 30 and 90\u2009days, hepatorenal syndrome (HRS), acute kidney injury (AKI), hepatic encephalopathy (HE) and drug\u2010related adverse events (AE). Trial sequential analyses were performed for the primary outcome of 90\u2010day mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We screened 419 articles and included six eligible studies (four RCTs and two matched cohort studies) with a total of 510 patients. Compared to standard medical treatment (SMT), prophylactic antibiotics were associated with a lower risk of infection at 30\u2009days (OR: 0.35, 95%CI: 0.20\u20130.59, <jats:italic>I<\/jats:italic>\n<jats:sup>2<\/jats:sup>\u2009=\u20090%), infection at 90\u2009days (OR: 0.26, 95%CI: 0.10\u20130.67, <jats:italic>I<\/jats:italic>\n<jats:sup>2<\/jats:sup>\u2009=\u20090%) and a lower rate of HE (OR: 0.32, 95%CI: 0.12\u20130.87, <jats:italic>I<\/jats:italic>\n<jats:sup>2<\/jats:sup>\u2009=\u20090%). However, prophylactic antibiotics did not improve 90\u2010day survival, sepsis\u2010related mortality, HRS, or AKI. The risks of drug\u2010related AE and fungal infections were similar in patients with AH who received prophylactic antibiotics or SMT. Using trial sequential analysis, the minimum sample size required to detect a 15% relative risk reduction in 90\u2009days mortality with prophylactic antibiotics was 1171.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In hospitalized AH patients receiving steroid therapy, prophylactic antibiotics reduced the risk of infection and HE, but did not improve survival or prevent AKI compared to SMT.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.16014","type":"journal-article","created":{"date-parts":[[2024,6,22]],"date-time":"2024-06-22T04:49:28Z","timestamp":1719031768000},"page":"2469-2476","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Prophylactic antibiotics in patients with alcohol\u2010associated hepatitis receiving steroids: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2417-7045","authenticated-orcid":false,"given":"Joo Wei E.","family":"Quek","sequence":"first","affiliation":[{"name":"Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing Hong","family":"Loo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Changi General Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aunchalee","family":"Jaroenlapnopparat","sequence":"additional","affiliation":[{"name":"Department of Medicine Mount Auburn Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cesar","family":"Jimenez","sequence":"additional","affiliation":[{"name":"\u00c0rea de malalties digestives Hospital Vall d'Hebron  Barcelona Spain"},{"name":"Department de Medicina, Facultat de Medicina CIBERehD, Universitat Aut\u00f2noma de Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa","family":"Al\u2010Karaghouli","sequence":"additional","affiliation":[{"name":"Liver Unit, Division of Gastroenterology University of Alberta  Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Vargas","sequence":"additional","affiliation":[{"name":"\u00c0rea de malalties digestives Hospital Vall d'Hebron  Barcelona Spain"},{"name":"Department de Medicina, Facultat de Medicina CIBERehD, Universitat Aut\u00f2noma de Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Pablo","family":"Arab","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Schulich School of Medicine Western University &amp; London Health Sciences Centre  London Ontario Canada"},{"name":"Department of Epidemiology and Biostatistics, Schulich School of Medicine Western University  London Ontario Canada"},{"name":"Departamento de Gastroenterologia, Escuela de Medicina Pontificia Universidad Catolica de Chile  Santiago Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan G.","family":"Abraldes","sequence":"additional","affiliation":[{"name":"Liver Unit, Division of Gastroenterology University of Alberta  Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0727-1183","authenticated-orcid":false,"given":"Yu Jun","family":"Wong","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"},{"name":"Department of Gastroenterology and Hepatology Changi General Hospital  Singapore Singapore"},{"name":"Liver Unit, Division of Gastroenterology University of Alberta  Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,6,22]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.02.042"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.03.017"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31984"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1105703"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.04.062"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.12939"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.06.019"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.12.019"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201609-1848OC"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1786"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-016-4121-6"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2021.02.003"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_11_15_1","unstructured":"WellsG.The Newcastle\u2010Ottawa Scale (NOS) for assessing the quality of non\u2010randomised studies in meta\u2010analyses. 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