Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis.
Published on Aug 1, 2021in Journal of Hepatology20.582
· DOI :10.1016/J.JHEP.2021.03.026
BACKGROUND AND AIMS Antibiotic prophylaxis reduces the risk of infection and mortality in cirrhotic patients with acute variceal bleeding (AVB). This study examines the incidence and risk factors of bacterial infections during hospitalization in patients with AVB on antibiotic prophylaxis. METHODS Post-hoc analysis of the database of an international, multicenter, observational study designed to examine the role of preemptive TIPS in patients with cirrhosis and AVB. Data collected on patients with cirrhosis hospitalized for AVB (n=2138) from a prospective cohort (October 2013-May 2015) at 34 referral centers, and retrospective cohort (October 2011-September 2013) at 19 of these centers. The primary outcome was incidence of bacterial infection during hospitalization. RESULTS 1656 patients out of 1770 (93.6%) received antibiotic prophylaxis, the most frequently used being third-generation cephalosporins (76.2%) and quinolones (19.0%). Of these, 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 (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 (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 infection is the most frequent and occurs 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.