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

Martínez, Javier; Hernández‐Gea, Virginia; Rodríguez-de-Santiago, Enrique; Téllez, Luís; Procopeţ, Bogdan; Giráldez, Álvaro; Amitrano, Lucio; Villanueva, Càndid; Thabut, Dominique; Ibáñez‐Samaniego, Luis; Silva‐Junior, Gilberto; Genescà, Joan; Bureau, Christophe; Trebicka, Jonel; Bañares, Rafael; Krag, Aleksander; Llop, Elba; Laleman, Wim; Palazón, José M.; Castellote, José; Rodrigues, Susana; Gluud, Lise Lotte; Noronha-Ferreira, Carlos; Cañete, Núria; Rodrı́guez, Manuel; Ferlitsch, Arnulf; Schwarzer, R; Mundi, José Luis; Grønbæk, Henning; Hernández‐Guerra, Manuel; Sassatelli, Romano; Dell’Era, Alessandra; Senzolo, Marco; Abraldes, Juan G.; Romero–Gómez, Manuel; Zipprich, Alexander; Casas, Meritxell; Masnou, Helena; Primignani, Massimo; Nevens, Frederik; Calleja, José Luís; Jansen, Christian; Robic, Marie Angèle; Conejo, Irene; Catalina, María Vega; Rudler, Marika; Alvarado, Edilmar; Pérez-Campuzano, Valeria; Guardascione, Maria Anna; Fischer, Petra; Bosch, Jaime; García‐Pagán, Juan Carlos; Albillos, Agustı́n

doi:10.1016/j.jhep.2021.03.026

Cited by 43 publications

(36 citation statements)

References 27 publications

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“…34 Recent study by Martinez et al in patients with acute variceal bleeding, showed that Child-Pugh B and C, and Grade III/IV hepatic encephalopathy were independently associated with bacterial infection. 44 The mechanisms underlying the interaction between the immune and nervous systems are not entirely clear but are possibly mediated by the neural pathways that are known to regulate the immune system. 45,46 The central nervous system can affect the immune function through the HPA directly through the innervation of the immune organs/cells.…”

Section: Discussionmentioning

confidence: 99%

Overt hepatic encephalopathy is an independent risk factor for de novo infection in cirrhotic patients with acute decompensation

Alabsawy

Shalimar

Sheikh

et al. 2022

Aliment Pharmacol Ther

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Background:The occurrence of overt hepatic encephalopathy (OHE) is associated with increased mortality. HE is commonly precipitated by infection, but whether HE predisposes to new infection is unclear. This study aimed to test if OHE predisposes to de novo infection during hospitalisation and its association with short-term mortality.Aims and Methods: Seven hundred and fifty-nine consecutive patients were identified at two institutions from prospectively maintained clinical databases of cirrhotic patients admitted with acute decompensation (AD). Infection and HE data were collected on the day of admission, and the occurrence of de novo infections was assessed for 28 days after admission. EASL-CLIF organ failure criteria were used to determine the presence of organ failures. Multivariable analysis using the logistic regression model was used to assess predictors of 28-day mortality and de novo infection.Results: Patients were divided into four groups; no baseline OHE or infection (n = 352); OHE with no baseline Infection (n = 221); no OHE but baseline infection (n = 100) and OHE with baseline infection (n = 86). On multivariate analyses, OHE (OR, 1.532 [95% CI, 1.061-2.300, P = 0.024]), and admission to ITU (OR, 2.303 [95% CI, 1.508-3.517, P < 0.001]) were independent risk factors for de novo infection.28-day mortality was 25.3%, 60.2%, 55.0% and 72.1% in the 4-groups respectively.Age, INR and creatinine were independently predictive of mortality. The presence of overt HE, infection, coagulation, kidney, circulatory, respiratory and liver failures were significantly associated with higher mortality. Conclusion:OHE is an independent risk factor for de novo infection in cirrhotic patients with AD.

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Section: Discussionmentioning

confidence: 99%

Overt hepatic encephalopathy is an independent risk factor for de novo infection in cirrhotic patients with acute decompensation

Alabsawy

Shalimar

Sheikh

et al. 2022

Aliment Pharmacol Ther

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“…In a recent, nationwide study from Spain including 1656 patients with cirrhosis hospitalized for VH between 2013 and 2015, Martinez et al investigated current epidemiology and trends of bacterial infections in these patients [20]. Interestingly, despite prophylaxis as currently recommended by international guidelines [5][6][7], 20% of patients developed bacterial infections, particularly respiratory tract infection.…”

Section: Antibiotic Prophylaxismentioning

confidence: 99%

“…Interestingly, despite prophylaxis as currently recommended by international guidelines [5][6][7], 20% of patients developed bacterial infections, particularly respiratory tract infection. Development of infection was observed early (median time from admission 3 days) and was independently associated with Child C class (odds ratio (OR): 3.1; 95% CI: 1.4-6.7), Grade III-IV encephalopathy at admission (OR: 2.8; 95% CI: 1.8-4.4), orotracheal intubation for endoscopy (OR: 2.6; 95% CI: 1.8-3.8), and placement of nasogastric tube/balloon tamponade (OR: 1.7; 95% CI: 1.2-2.4 and 2.4; 95% CI: 1.2-4.9, respectively) [20]. Such procedures should, therefore, be minimized whenever possible, particularly in patients with additional risk factors, and active screening for respiratory infections shall be performed in case of early clinical deterioration.…”

Section: Antibiotic Prophylaxismentioning

confidence: 99%

“…Endotracheal intubation to protect the airway system may be considered in patients with massive bleeding prior to endoscopy. However, whether intubation is really protective or increases the risk of respiratory infections is unclear [20], therefore, it cannot be recommended for every patient.…”

Section: Specific Management Of Acute Esophageal Vhmentioning

confidence: 99%

“…In patients with uncontrolled bleeding, guidelines recommend placement of balloon tamponade (Sengastaken-Blackemore or Minnesota tubes) [5][6][7][8]. However, tamponade carries a high risk of complications, particularly respiratory infection [20], and shall be considered only as a temporary (maximum 24 h) bridge to TIPS [5]. Recent data suggest that placement of a self-expandable esophageal metal stent (placed orally or endoscopically) may be associated with greater bleeding control and lower adverse events compared to balloon [48].…”

Section: Endoscopic Therapymentioning

confidence: 99%

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Recent Advances in the Management of Acute Variceal Hemorrhage

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Gastrointestinal bleeding is one of the most relevant causes of death in patients with cirrhosis and clinically significant portal hypertension, with gastroesophageal varices being the most frequent source of hemorrhage. Despite survival has improved thanks to the standardization on medical treatment aiming to decrease portal hypertension and prevent infections, mortality remains significant. In this review, our goal is to discuss the most recent advances in the management of esophageal variceal hemorrhage in cirrhosis with specific attention to the treatment algorithms involving the use of indirect measurement of portal pressure (HVPG) and transjugular intrahepatic portosystemic shunt (TIPS), which aim to further reduce mortality in high-risk patients after acute variceal hemorrhage and in the setting of secondary prophylaxis.

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

Cited by 43 publications

References 27 publications

Overt hepatic encephalopathy is an independent risk factor for de novo infection in cirrhotic patients with acute decompensation

Overt hepatic encephalopathy is an independent risk factor for de novo infection in cirrhotic patients with acute decompensation

Recent Advances in the Management of Acute Variceal Hemorrhage

General Management of Acute Variceal Bleeding

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