| Antibiotic prophylaxis in variceal hemorrhage: timing, effectiveness and Clostridium difficile rates. | |
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MedLine Citation:
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PMID: 21072894 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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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Authors:
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Matthew R L Brown; Graeme Jones; Kathryn L Nash; Mark Wright; Indra Neil Guha |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: World journal of gastroenterology : WJG Volume: 16 ISSN: 1007-9327 ISO Abbreviation: World J. Gastroenterol. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-12 Completed Date: 2011-02-28 Revised Date: 2011-07-21 |
Medline Journal Info:
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Nlm Unique ID: 100883448 Medline TA: World J Gastroenterol Country: China |
Other Details:
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Languages: eng Pagination: 5317-23 Citation Subset: IM |
Affiliation:
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National Institute for Health Research Nottingham Digestive Diseases Centre Biomedical Research Unit, Nottingham University Hospitals NHS Trust, E Level West Block, Queens Medical Centre Campus, Derby Road, Nottingham, NG7 2UH, United Kingdom. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Anti-Bacterial Agents* / pharmacology, therapeutic use Antibiotic Prophylaxis* Clostridium Infections* / etiology, prevention & control Clostridium difficile / drug effects* Endoscopy* / adverse effects Esophageal and Gastric Varices* / microbiology, mortality, surgery Female Gastrointestinal Hemorrhage* / microbiology, mortality, surgery Humans Male Middle Aged Retrospective Studies Survival Rate |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents |
| Comments/Corrections | |
Comment In:
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World J Gastroenterol. 2011 May 14;17(18):2356
[PMID:
21633604
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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