Antibiotic Prophylaxis for Upper Gastrointestinal Bleed in Liver Cirrhosis; Less May Be More.

Autor: B Hadi Y; Department of Medicine, West Virginia University, Morgantown, USA., Khan RS; West Virginia University, Morgantown, USA., Lakhani DA; Department of Radiology, Ruby Memorial Hospital, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA. dhairya.lakhani@hsc.wvu.edu., Khan AY; West Virginia University, Morgantown, USA., Jannat RU; West Virginia University, Morgantown, USA., Khan AA; Section of Gastroenterology, Department of Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA., Naqvi SF; West Virginia University, Morgantown, USA., Obeng G; West Virginia University, Morgantown, USA., Kupec JT; Department of Medicine, West Virginia University, Morgantown, USA., Singal AK; Sanford School of Medicine, University of South Dakota, Sioux Falls, USA.; Avera Transplant Institute, Sioux Falls, SD, USA.
Jazyk: angličtina
Zdroj: Digestive diseases and sciences [Dig Dis Sci] 2023 Jan; Vol. 68 (1), pp. 284-290. Date of Electronic Publication: 2022 Apr 25.
DOI: 10.1007/s10620-022-07481-0
Abstrakt: Introduction: Administration of antibiotics in patients with cirrhosis and upper gastrointestinal bleeding has been shown to improve outcomes. Little is known regarding optimum duration of prophylactic antibiotics. Seven days of antibiotics are generally recommended but very few studies have compared antibiotic duration to clinical outcomes in current available scientific literature. The goal of our study was to study the effect of shorter antibiotic duration on patient outcomes.
Methods: We conducted a retrospective cohort study of patients with cirrhosis presenting with upper GI bleeding at our institute from 2010 to 2018. Patients were divided into three cohorts based on duration of antibiotic administration for prophylaxis: 1-3 days of antibiotics, 4-6 days of antibiotics and 7 days or more of antibiotics. Rates of infection diagnosis within 30 days, rebleeding, and mortality were compared between the three groups with Chi square, Fisher Exact and Kruskall-Wallace tests. Multivariable analysis was conducted to evaluate independent risk factors for infection.
Results: Medical charts of 980 patients with cirrhosis and upper GI bleeding during the study period were reviewed. A total of 303 with upper gastrointestinal bleeding were included in the final sample, of these 243 patients received antibiotics for prophylaxis and were included for analysis. Seventy-seven patients received antibiotic therapy for 3 days or less, 69 patients for 4-6 days, and 97 patients longer than 6 days. The three groups were well matched in demographic and clinical variables. Twenty-seven patients developed infections within 30 days of bleeding. MELD-Na score at presentation and presence of ascites were associated with infection within 30 days. Rates of infection were not statistically different between the three antibiotic groups (p = 0.78). In the thirty days following the GI bleed, pneumonia was the most diagnosed infection (eleven patients) followed by urinary tract infections (eight patients). Four patients developed spontaneous bacterial peritonitis and three were diagnosed with bacteremia. There was no difference in time to infection (Kruskall Wallace test p = 0.75), early re-bleeding (p = 0.81), late re-bleeding (p = 0.37) and in-hospital mortality (p = 0.94) in the three groups. Six patients in the cohort developed C. Difficile infection; no patient in the short antibiotic group developed C. Difficile infection.
Conclusion: Short course of antibiotics for prophylaxis (3 days) appears safe and adequate for prophylaxis in patients with cirrhosis with upper gastrointestinal bleeding if there is no active infection.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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