Antibiotic prophylaxis in variceal hemorrhage: timing, effectiveness and Clostridium difficile rates
Antibiotic prophylaxis in variceal hemorrhage: timing, effectiveness and Clostridium difficile rates
AIM: To investigate if antibiotics administered within 8 h of endoscopy reduce mortality or increase the incidence of Clostridium difficile infection (CDI).
METHODS: A 2-year retrospective analysis of all patients who presented with first variceal hemorrhage was undertaken. The primary outcome measure was 28-d mortality. Secondary outcome measures were 28-d rebleeding rates and 28-d incidence of CDI. All patients were admitted to a tertiary liver unit with a consultant-led, 24-h endoscopy service. Patients received standard care including terlipressin therapy. Data collection included: primary and secondary outcome measures, timing of first administration of intravenous antibiotics, etiology of liver disease, demographics, endoscopy details and complications. A prospective study was undertaken to determine the incidence of CDI in the study population and general medical inpatients admitted for antibiotic therapy of at least 5 d duration. Statistical analysis was undertaken using univariate, non-parametric tests and multivariate logistic regression analysis.
RESULTS: There were 70 first presentations of variceal hemorrhage during the study period. Seventy percent of cases were male and 65.7% were due to chronic alcoholic liver disease. In total, 64/70 (91.4%) patients received antibiotics as prophylaxis during their admission. Specifically, 53/70 (75.7%) received antibiotics either before endoscopy or within 8 h of endoscopy [peri-endoscopy (8 h) group], whereas 17/70 (24.3%) received antibiotics at > 8 h after endoscopy or not at all (non peri-endoscopy group). Overall mortality and rebleeding rates were 13/70 (18.6%) and 14/70 (20%), respectively. The peri-endoscopy (8 h) group was significantly less likely to die compared with the non peri-endoscopy group [13.2% vs 35.3%, P = 0.04, odds ratio (OR) = 0.28 (0.078-0.997)] and showed a trend towards reduced rebleeding [17.0% vs 29.4%, P = 0.27, OR = 0.49 (0.14-1.74)]. On univariate analysis, the non peri-endoscopy group [P = 0.02, OR = 3.58 (1.00-12.81)], higher model for end-stage liver disease (MELD) score (P = 0.02), presence of hepatorenal syndrome [P < 0.01, OR = 11.25 (2.24-56.42)] and suffering a clinical episode of sepsis [P = 0.03, OR = 4.03 (1.11-14.58)] were significant predictors of death at 28 d. On multivariate logistic regression analysis, lower MELD score [P = 0.01, OR = 1.16 (1.04-1.28)] and peri-endoscopy (8 h) group [P = 0.01, OR = 0.15 (0.03-0.68)] were independent predictors of survival at 28 d. The CDI incidence (5.7%) was comparable to that in the general medical population (5%).
CONCLUSION: Antibiotics administered up to 8 h following endoscopy were associated with improved survival at 28 d. CDI incidence was comparable to that in other patient groups.
Adult, Aged, Anti-Bacterial Agents/pharmacology, Antibiotic Prophylaxis, Clostridioides difficile/drug effects, Clostridium Infections/etiology, Endoscopy/adverse effects, Esophageal and Gastric Varices/microbiology, Female, Gastrointestinal Hemorrhage/microbiology, Humans, Male, Middle Aged, Retrospective Studies, Survival Rate
5317-23
Brown, Matthew R L
0a41eab2-316f-46b3-9345-72ff9fabcbb0
Jones, Graeme
f26c7d03-cd84-40c8-ae3a-286e861a5a29
Nash, Kathryn L
eda1639b-5700-44bb-9d15-93e14c646b2a
Wright, Mark
43325ef9-3459-4c75-b3bf-cf8d8dac2a21
Guha, Indra Neil
a3dddb81-7413-4309-b85d-afa33b8d3fce
14 November 2010
Brown, Matthew R L
0a41eab2-316f-46b3-9345-72ff9fabcbb0
Jones, Graeme
f26c7d03-cd84-40c8-ae3a-286e861a5a29
Nash, Kathryn L
eda1639b-5700-44bb-9d15-93e14c646b2a
Wright, Mark
43325ef9-3459-4c75-b3bf-cf8d8dac2a21
Guha, Indra Neil
a3dddb81-7413-4309-b85d-afa33b8d3fce
Brown, Matthew R L, Jones, Graeme, Nash, Kathryn L, Wright, Mark and Guha, Indra Neil
(2010)
Antibiotic prophylaxis in variceal hemorrhage: timing, effectiveness and Clostridium difficile rates.
World Journal of Gastroenterology, 16 (42), .
(doi:10.3748/wjg.v16.i42.5317).
Abstract
AIM: To investigate if antibiotics administered within 8 h of endoscopy reduce mortality or increase the incidence of Clostridium difficile infection (CDI).
METHODS: A 2-year retrospective analysis of all patients who presented with first variceal hemorrhage was undertaken. The primary outcome measure was 28-d mortality. Secondary outcome measures were 28-d rebleeding rates and 28-d incidence of CDI. All patients were admitted to a tertiary liver unit with a consultant-led, 24-h endoscopy service. Patients received standard care including terlipressin therapy. Data collection included: primary and secondary outcome measures, timing of first administration of intravenous antibiotics, etiology of liver disease, demographics, endoscopy details and complications. A prospective study was undertaken to determine the incidence of CDI in the study population and general medical inpatients admitted for antibiotic therapy of at least 5 d duration. Statistical analysis was undertaken using univariate, non-parametric tests and multivariate logistic regression analysis.
RESULTS: There were 70 first presentations of variceal hemorrhage during the study period. Seventy percent of cases were male and 65.7% were due to chronic alcoholic liver disease. In total, 64/70 (91.4%) patients received antibiotics as prophylaxis during their admission. Specifically, 53/70 (75.7%) received antibiotics either before endoscopy or within 8 h of endoscopy [peri-endoscopy (8 h) group], whereas 17/70 (24.3%) received antibiotics at > 8 h after endoscopy or not at all (non peri-endoscopy group). Overall mortality and rebleeding rates were 13/70 (18.6%) and 14/70 (20%), respectively. The peri-endoscopy (8 h) group was significantly less likely to die compared with the non peri-endoscopy group [13.2% vs 35.3%, P = 0.04, odds ratio (OR) = 0.28 (0.078-0.997)] and showed a trend towards reduced rebleeding [17.0% vs 29.4%, P = 0.27, OR = 0.49 (0.14-1.74)]. On univariate analysis, the non peri-endoscopy group [P = 0.02, OR = 3.58 (1.00-12.81)], higher model for end-stage liver disease (MELD) score (P = 0.02), presence of hepatorenal syndrome [P < 0.01, OR = 11.25 (2.24-56.42)] and suffering a clinical episode of sepsis [P = 0.03, OR = 4.03 (1.11-14.58)] were significant predictors of death at 28 d. On multivariate logistic regression analysis, lower MELD score [P = 0.01, OR = 1.16 (1.04-1.28)] and peri-endoscopy (8 h) group [P = 0.01, OR = 0.15 (0.03-0.68)] were independent predictors of survival at 28 d. The CDI incidence (5.7%) was comparable to that in the general medical population (5%).
CONCLUSION: Antibiotics administered up to 8 h following endoscopy were associated with improved survival at 28 d. CDI incidence was comparable to that in other patient groups.
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Published date: 14 November 2010
Keywords:
Adult, Aged, Anti-Bacterial Agents/pharmacology, Antibiotic Prophylaxis, Clostridioides difficile/drug effects, Clostridium Infections/etiology, Endoscopy/adverse effects, Esophageal and Gastric Varices/microbiology, Female, Gastrointestinal Hemorrhage/microbiology, Humans, Male, Middle Aged, Retrospective Studies, Survival Rate
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Local EPrints ID: 478076
URI: http://eprints.soton.ac.uk/id/eprint/478076
ISSN: 1007-9327
PURE UUID: bca04d63-80f3-4108-ad5d-ac63b11e9a83
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Date deposited: 21 Jun 2023 16:53
Last modified: 17 Mar 2024 02:13
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Author:
Matthew R L Brown
Author:
Graeme Jones
Author:
Kathryn L Nash
Author:
Mark Wright
Author:
Indra Neil Guha
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