Systemic Antibiotic Therapy Prevents Bacterial Infection in Cirrhotic Patients With Gastrointestinal Hemorrhage

Abstract

This randomized prospective study was aimed at assessing the efficiency of a systemic antibiotic therapy for the prevention of bacterial infections in cirrhotic patients with gastrointestinal hemorrhage by ruptured esophageal varices. For 15 mo, all patients hospitalized with no infection on admission, were included in the study. Starting on admission day, patients in group A received ofloxacin (400 mglday) for 10 days, first intravenously then orally. They also received an intravenous bolus of amoxicillin plus clavulanic acid (1 g) before each endoscopy performed during hemorrhage. Patients in group B received antibiotic therapy only in cases of established or suspected infection. Chest X-ray, blood culture, urine culture and sputum and ascitic fluid culture were performed every day for 7 days, then every other day for the next 7 days. A bronchial sampling was performed with the Wimberley technique on patients with endotracheal intubation. Ninety-one patients (55 men, 54 2 11 years, 78% Child Pugh class C) were included in the study (46 in group A, 45 in group B). Group A showed a lower incidence of bacterial infections than group B (20% vs. 66%; p < 0.001). Breakdown of positive bacteriological sampling was as follows: blood (6 vs. 17), ascites (3 vs. 7), lungs (2 vs. 18), urine (1 vs. 10). The 2-wk mortality rate was 24% in group A and 35% in group B. (HEPATOLOGY 1994;2034-38.)

Independent Factors Associated with Recurrent Bleeding in Cirrhotic Patients with Esophageal Variceal Hemorrhage

“…Indeed, early rebleeding in our study was significantly associated with infection (P = 0.042, \0.05). Bacterial infection occurs early in cirrhotic patients with variceal bleeding, and this finding is consistent with those of previous studies [13][14][15][16]. Our study revealed that enteric aerobic gram-negative bacteria are the most common causative organisms in patients with acute gastrointestinal bleeding.…”

Selective intestinal decontamination with norfloxacin reduces bacterial translocation in ascitic cirrhotic rats exposed to hemorrhagic shock

“…11,12,25 In addition, ischemia increases intestinal permeability to tions in ascitic rats undergoing HS, since it is known that in bleeding cirrhotic patients, infections occur macromolecules 12 and could promote the passage of endotoxins to portal and peripheral circulation-phe-within the first 10 days after HS. [1][2][3] In conclusion, the results of the present study sugnomena widely associated with BT. 26 As well, HS can impair the immune response, thus permitting the gest that HS further enhances BT in ascitic cirrhotic rats, and that SID is effective in decreasing this incispread of translocated bacteria.…”

“…9,10 The 3 raises the possibility that BT could be further enhanced already present in advanced cirrhotic subjects.…”

The effects of cefazolin on cirrhotic patients with acute variceal hemorrhage after endoscopic interventions

“…Many clinical trials proved that prophylactic antibiotics with oral norfloxacin, intravenous ciprofloxacin, or ceftriaxone in cirrhotic patients with gastrointestinal (GI) bleeding can reduce infections and mortality [2][3][4][5]. Previous studies showed that enteric aerobic Gram-negative bacteria (GNB) are the most common causative organisms in patients with acute hemorrhage [2,3,[6][7][8]. However, there are some epidemiological changes in the etiology of infections because Gram-positive cocci (GPC) have markedly increased in cirrhotic patients, probably due to more invasive procedures in treating liver diseases in recent years [5].…”