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

Abstract:

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.

Copyright © 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Keywords: Acute variceal bleeding, Antibiotic prophylaxis, Bacterial infection, Cirrhosis, Respiratory infection

References:

Authors

• Juan G Abraldes |
• Agustín Albillos |
• Edilmar Alvarado |
• Lucio Amitrano |
• Rafael Bañares |
• Jaime Bosch |
• Christophe Bureau |
• José Luis Calleja |
• Nuria Cañete |
• Meritxell Casas |
• Jose Castellote |
• María Vega Catalina |
• Irene Conejo |
• Alessandra Dell'Era |
• Arnulf Ferlitsch |
• Petra Fischer |
• Juan Carlos García-Pagán |
• Joan Genescà |
• Álvaro Giráldez |
• Lise L Gluud |
• Henning Gronbaek |
• Maria Anna Guardascione |
• Virginia Hernández-Gea |
• Manuel Hernández-Guerra |
• Luis Ibañez-Samaniego |
• Christian Jansen |
• Aleksander Krag |
• Wim Laleman |
• Elba Llop |
• Javier Martínez |
• Helena Masnou |
• Jose Luis Mundi |
• Frederik Nevens |
• Carlos Noronha-Ferreira |
• Jose Maria Palazon |
• Valeria Perez-Campuzano |
• Massimo Primignani |
• Bogdan Procopet |
• Marie Angèle Robic |
• Susana Rodrigues |
• Manuel Rodríguez |
• Enrique Rodríguez-de-Santiago |
• Manuel Romero-Gómez |
• Marika Rudler |
• Romano Sassatelli |
• Rémy Schwarzer |
• Marco Senzolo |
• Gilberto Silva-Junior |
• Luis Téllez |
• Dominique Thabut |
• Jonel Trebicka |
• Càndid Villanueva |
• Alexander Zipprich |