Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis.

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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.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.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).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.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.

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Authors: Javier Martínez, Virginia Hernández-Gea, Enrique Rodríguez-de-Santiago, Luis Téllez, Bogdan Procopet, Álvaro Giráldez, Lucio Amitrano, Candid Villanueva, Dominique Thabut, Luis Ibañez-Samaniego, Gilberto Silva-Junior, Joan Genescà, Christophe Bureau, Jonel Trebicka, Rafael Bañares, Aleksander Krag, Elba Llop, Wim Laleman, Jose María Palazon, Jose Castellote, Susana Rodrigues, Lise L Gluud, Carlos Noronha-Ferreira, Nuria Cañete, Manuel Rodríguez, Arnulf Ferlitsch, Remy Schwarzer, Jose Luis Mundi, Henning Gronbaek, Manuel Hernández-Guerra, Romano Sassatelli, Alessandra Dell Era, Marco Senzolo, Juan G Abraldes, Manuel Romero-Gomez, Alexander Zipprich, Meritxell Casas, Helena Masnou, Massimo Primignani, Frederik Nevens, Jose Luis Calleja, Christian Jansen, Marie Angèle Robic, Irene Conejo, Maria Vega Catalina, Marika Rudler, Edilmar Alvarado, Valeria Perez-Campuzano, Maria Anna Guardascione, Petra Fischer, Jaime Bosch, Juan Carlos García-Pagán, Agustín Albillos, International Variceal Bleeding Observational Study Group and Baveno Cooperation