Abstract
BackgroundInfections in cirrhotic patients with upper gastrointestinal bleeding are a common event causing severe complication and mortality. This study aimed to identify risk factors that may predict rebleeding, bacterial infections, and the impact of antibiotic prophylaxis on mortality at different stages of cirrhosis following acute peptic ulcer bleeding (PUB).MethodsA hospital-based retrospective cohort study was conducted on 235 cirrhotic patients with acute peptic ulcer hemorrhage who underwent therapeutic endoscopic procedures between January 2008 and January 2014 (n = 235); of these, 88 patients received prophylactic intravenous ceftriaxone (antibiotic group) and 147 patients did not (nil-antibiotic group). The recorded outcomes were length of hospital stay, bacterial infection, rebleeding, and in-hospital mortality.ResultsForty-eight (20.4 %) patients experienced ulcer rebleeding and 46 (19.6 %) developed bacterial infections. More patients suffered from infection and recurrent bleeding in the nil-antibiotic group than the antibiotic group (25.2 % vs. 10.2 %, p = 0.005 and 30.6 % vs. 3.4 %; p < 0.001, respectively). The predictive risk factors for rebleeding were the Rockall score (p = 0.004), units of blood transfusion (p = 0.031), and no antibiotic prophylaxis (p <0.001); for bacterial infections, they were the Child-Pugh score (p = 0.003), active alcoholism (p = 0.035), and no antibiotic prophylaxis (p = 0.009). Overall, 40 (17 %) patients died during hospitalization. The Rockall score and rebleeding were predictive factors for in-hospital mortality. In subgroup analysis, survival was significantly reduced in decompensated patients (p = 0.034).ConclusionsThis study suggests that antibiotic prophylaxis after endoscopic hemostasis for acute PUB prevented infections and reduced rebleeding events in cirrhotic patients. Antibiotic prophylaxis improved survival among decompensated cohort following PUB. The Rockall score and rebleeding were predictive risk factors for in-hospital mortality.
Highlights
Infections in cirrhotic patients with upper gastrointestinal bleeding are a common event causing severe complication and mortality
This study suggests that antibiotic prophylaxis after endoscopic hemostasis for acute peptic ulcer bleeding (PUB) prevented infections and reduced rebleeding events in cirrhotic patients
This is evidenced by reports demonstrating that oral administration of non-absorbable antibiotics markedly reduces the incidence of bacterial infections in cirrhotic patients with gastrointestinal hemorrhage [3]
Summary
Infections in cirrhotic patients with upper gastrointestinal bleeding are a common event causing severe complication and mortality. Upper gastrointestinal bleeding in cirrhotic patients is associated with an increased rate of failure to control bleeding and can result in mortality when bacterial infections occur [1, 2]. This is evidenced by reports demonstrating that oral administration of non-absorbable antibiotics markedly reduces the incidence of bacterial infections in cirrhotic patients with gastrointestinal hemorrhage [3]. A multicenter prospective study from Italy reported that 10 % of patients with cirrhosis rebleed and 15 % of them died within 6 weeks after acute nonvariceal upper gastrointestinal bleeding [5]
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