Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis.

Martínez, Javier; Hernández-Gea, Virginia; Rodríguez-de-Santiago, Enrique; Téllez, Luis; Procopet, Bogdan; Giráldez, Álvaro; Amitrano, Lucio; Villanueva, Candid; Thabut, Dominique; Ibañez-Samaniego, Luis; Silva-Junior, Gilberto; Genescà, Joan; Bureau, Christophe; Trebicka, Jonel; Bañares, Rafael; Krag, Aleksander; Llop, Elba; Laleman, Wim; Palazon, Jose María; Castellote, Jose; ... (2021). Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis. Journal of hepatology, 75(2), pp. 342-350. Elsevier 10.1016/j.jhep.2021.03.026

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BACKGROUND & AIMS

Antibiotic prophylaxis reduces the risk of infection and mortality in patients with cirrhosis and acute variceal bleeding (AVB). This study examines the incidence of, and risk factors for, bacterial infections during hospitalization in patients with AVB on antibiotic prophylaxis.

METHODS

A post hoc analysis was performed using the database of an international, multicenter, observational study designed to examine the role of pre-emptive transjugular intrahepatic portosystemic shunts in patients with cirrhosis and AVB. Data were collected on patients with cirrhosis hospitalized for AVB (n = 2,138) from a prospective cohort (October 2013-May 2015) at 34 referral centers, and a retrospective cohort (October 2011-September 2013) at 19 of these centers. The primary outcome was incidence of bacterial infection during hospitalization.

RESULTS

A total of 1,656 patients out of 1,770 (93.6%) received antibiotic prophylaxis; third-generation cephalosporins (76.2%) and quinolones (19.0%) were used most frequently. Of the patients on antibiotic prophylaxis, 320 patients developed bacterial infection during hospitalization. Respiratory infection accounted for 43.6% of infections and for 49.7% of infected patients, and occurred early after admission (median 3 days, IQR 1-6). On multivariate analysis, respiratory infection was independently associated with Child-Pugh C (odds ratio [OR] 3.1; 95% CI 1.4-6.7), grade III-IV encephalopathy (OR 2.8; 95% CI 1.8-4.4), orotracheal intubation for endoscopy (OR 2.6; 95% CI 1.8-3.8), nasogastric tube placement (OR 1.7; 95% CI 1.2-2.4) or esophageal balloon tamponade (OR 2.4; 95% CI 1.2-4.9).

CONCLUSION

Bacterial infections develop in almost one-fifth of patients with AVB despite antibiotic prophylaxis. Respiratory infection is the most frequent, is an early event after admission, and is associated with advanced liver failure, severe hepatic encephalopathy and use of nasogastric tube, orotracheal intubation for endoscopy or esophageal balloon tamponade.

LAY SUMMARY

Bacterial infections develop during hospitalization in close to 20% of patients with acute variceal bleeding despite antibiotic prophylaxis. Respiratory bacterial infections are the most frequent and occur early after admission. Respiratory infection is associated with advanced liver disease, severe hepatic encephalopathy and a need for a nasogastric tube, orotracheal intubation for endoscopy or esophageal balloon tamponade.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie

UniBE Contributor:

Bosch, Jaime

ISSN:

1600-0641

Publisher:

Elsevier

Language:

English

Submitter:

Rahel Fuhrer

Date Deposited:

06 Jul 2021 14:34

Last Modified:

21 Jul 2021 01:34

Publisher DOI:

10.1016/j.jhep.2021.03.026

PubMed ID:

33845059

Uncontrolled Keywords:

Acute variceal bleeding Antibiotic prophylaxis Bacterial infection Cirrhosis Respiratory infection

BORIS DOI:

10.48350/157349

URI:

https://boris.unibe.ch/id/eprint/157349

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