TY - JOUR
T1 - Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis
AU - Martínez, Javier
AU - Hernández-Gea, Virginia
AU - Rodríguez-de-Santiago, Enrique
AU - Téllez, Luis
AU - Procopet, Bogdan
AU - Giráldez, Álvaro
AU - Amitrano, Lucio
AU - Villanueva, Candid
AU - Thabut, Dominique
AU - Ibañez-Samaniego, Luis
AU - Silva-Junior, Gilberto
AU - Genescà, Joan
AU - Bureau, Christophe
AU - Trebicka, Jonel
AU - Bañares, Rafael
AU - Krag, Aleksander
AU - Llop, Elba
AU - Laleman, Wim
AU - Palazon, Jose María
AU - Castellote, Jose
AU - Rodrigues, Susana
AU - Gluud, Lise L
AU - Noronha-Ferreira, Carlos
AU - Cañete, Nuria
AU - Rodríguez, Manuel
AU - Ferlitsch, Arnulf
AU - Schwarzer, Remy
AU - Mundi, Jose Luis
AU - Gronbaek, Henning
AU - Hernández-Guerra, Manuel
AU - Sassatelli, Romano
AU - Dell Era, Alessandra
AU - Senzolo, Marco
AU - Abraldes, Juan G
AU - Romero-Gomez, Manuel
AU - Zipprich, Alexander
AU - Casas, Meritxell
AU - Masnou, Helena
AU - Primignani, Massimo
AU - Nevens, Frederik
AU - Calleja, Jose Luis
AU - Jansen, Christian
AU - Robic, Marie Angèle
AU - Conejo, Irene
AU - Catalina, Maria Vega
AU - Rudler, Marika
AU - Alvarado, Edilmar
AU - Perez-Campuzano, Valeria
AU - Guardascione, Maria Anna
AU - Fischer, Petra
AU - International Variceal Bleeding Observational Study Group and Baveno Cooperation
N1 - Copyright © 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - 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.
AB - 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.
KW - Acute variceal bleeding
KW - Antibiotic prophylaxis
KW - Bacterial infection
KW - Cirrhosis
KW - Respiratory infection
KW - Multivariate Analysis
KW - Humans
KW - Middle Aged
KW - Risk Factors
KW - Logistic Models
KW - Male
KW - Anti-Bacterial Agents/pharmacology
KW - Hemorrhage/epidemiology
KW - Bacterial Infections/drug therapy
KW - Incidence
KW - Cephalosporins/pharmacology
KW - Female
KW - Aged
KW - Antibiotic Prophylaxis/methods
KW - Esophageal and Gastric Varices/complications
KW - Quinolones/pharmacology
KW - Odds Ratio
UR - http://www.scopus.com/inward/record.url?scp=85107884249&partnerID=8YFLogxK
U2 - 10.1016/j.jhep.2021.03.026
DO - 10.1016/j.jhep.2021.03.026
M3 - Journal article
C2 - 33845059
SN - 0168-8278
VL - 75
SP - 342
EP - 350
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 2
ER -