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

Abstract

Abstract Background Antibiotics in patients with cirrhosis and upper gastrointestinal bleeding are shown to improve outcomes. Little is known regarding optimum duration of prophylactic antibiotics, with 7 days of therapy generally recommended. Antibiotic duration has not been compared to outcomes in current scientific literature. The goal of our study was to study the effect of shorter antibiotic duration on outcomes. Methods This was a retrospective cohort study of patients with cirrhosis presenting with upper GI bleeding at our institute from 2010-2018. Patients were divided into three cohorts based on duration of antibiotic administration: 1-3 days, 4-6 days, and 7 days or more. Rates of infection within 30 days, time to infection, rebleeding and mortality were compared between the three groups. Multivariable analysis was conducted to evaluate independent risk factors for infection. Results Medical charts of 943 patients with cirrhosis and upper GI bleed were reviewed. 303 patients did not have concomitant confirmed or suspected infection on presentation, 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 >6 days. The groups were well matched in demographic & clinical variables. 27 patients developed infections within 30 days of bleed. High MELD score at presentation and presence of ascites were associated with infection within 30 days. Rates of infection were not statistically different between the antibiotic groups (p= 0.78). In the 30 days following GI bleed, pneumonia was the most diagnosed infection (11 patients) followed by UTI (8 patients). Four patients developed spontaneous bacterial peritonitis and 3 were diagnosed with bacteremia. There was no difference in time to infection (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 developed C. Difficile infection, none of whom were in the short antibiotic group. Conclusion Short course of antibiotics for prophylaxis (3 days) appears safe and adequate for prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding if bleeding has abated and there is no active infection. Disclosures All Authors: No reported disclosures