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

JOURNAL OF HEPATOLOGY

卷:75

Article

Martinez, Javier^1,2  Hernandez-Gea, Virginia^2,3  Rodriguez-de-Santiago, Enrique^1,2  Tellez, Luis^1,2  Procopet, Bogdan^4,5  Giraldez, Alvaro⁶  Amitrano, Lucio⁷  Villanueva, Candid^2,8,9,10  Thabut, Dominique^11,12  Ibanez-Samaniego, Luis¹³  Silva-Junior, Gilberto³  Genesca, Joan^2,14,15  Bureau, Christophe¹⁶  Trebicka, Jonel^17,18  Banares, Rafael^2,13  Krag, Aleksander¹⁹  Llop, Elba^2,20  Laleman, Wim²¹  Maria Palazon, Jose²²  Castellote, Jose²³  Rodrigues, Susana²⁴  Gluud, Lise L.²⁵  Noronha-Ferreira, Carlos²⁶  Canete, Nuria²⁷  Rodriguez, Manuel²⁸  Ferlitsch, Arnulf²⁹  Schwarzer, Remy²⁹  Mundi, Jose Luis³⁰  Gronbaek, Henning³¹  Hernandez-Guerra, Manuel³²  Sassatelli, Romano³³  Dell'Era, Alessandra³⁴  Senzolo, Marco³⁵  Abraldes, Juan G.³⁶  Romero-Gomez, Manuel³⁷  Zipprich, Alexander³⁸  Casas, Meritxell³⁹  Masnoun, Helena⁴⁰  Primignani, Massimo⁴¹  Nevens, Frederik²¹  Luis Calleja, Jose^2,20  Jansen, Christian⁴²  Robic, Marie Angele¹⁶  Conejo, Irene^2,14,15  Vega Catalina, Maria^2,13  Rudler, Marika^10,12  Alvarado, Edilmar^2,8,9,10  Perez-Campuzano, Valeria³  Guardascione, Maria Anna⁷  Fischer, Petra^4,5  Bosch, Jaime^2,3,43  Carlos Garcia-Pagan, Juan^2,3  Albillos, Agustin^1,2 

[1] Univ Alcala, Hosp Univ Ramon y Cajal, Inst Ramon y Cajal Invest Sanitaria IRYCIS, Serv Gastroenterol & Hepatol, Madrid, Spain

[2] Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain

[3] Univ Barcelona, Hosp Clin, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Liver Unit,Barcelona Hepat Hemodynam Lab, Barcelona, Spain

[4] Reg Inst Gastroenterol & Hepatol Octavian Fodor, Hepatol Dept, Cluj Napoca, Romania

[5] Iuliu Hatieganu Univ Med & Pharm, Med Clin 3, Cluj Napoca, Romania

[6] Virgen del Rocio Univ Hosp, Inst Biomed Sevilla IBIS, Unit Clin Management Digest Dis, Liver Dis, Seville, Spain

[7] Osped A Cardarelli, Gastroenterol Unit, Naples, Italy

[8] Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Barcelona, Spain

[9] Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain

[10] Univ Autonoma Barcelona, Barcelona, Cerdanyola Del, Spain

[11] Grp Hosp Pitie Salpetriere Charles Foix, Paris, France

[12] Sorbonne Univ, Inst Cardiometab & Nutr ICAN, INSERM, Ctr Rech St Antoine CRSA, Paris, France

[13] Hosp Gen Univ Gregorio Maranon, Serv Med Aparato Digest Gregorio Maranon, CIBERehd, Madrid, Spain

[14] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Vall dHebron Inst Res VHIR, Liver Unit, Barcelona, Spain

[15] CIBERehd, Barcelona, Spain

[16] Univ Toulouse, Purpan Hosp, Dept Hepatogastroenterol, INSERM U858,CHU Toulouse, Toulouse, France

[17] Goethe Univ Frankfurt, Dept Internal Med 1, Frankfurt, Germany

[18] European Fdn Study Chron Liver Failure EF Clif, Barcelona, Spain

[19] Odense Univ Hosp, Dept Gastroenterol & Hepatol, Odense, Denmark

[20] Univ Autonoma Madrid, Hosp Univ Puerta Hierro, Liver Unit, CIBERehd, Madrid, Spain

[21] Katholieke Univ Leuven, Dept Gastroenterol & Hepatol, Div Liver & Biliopancreat Disorders, Univ Hosp Leuven, Leuven, Belgium

[22] Hosp Gen Univ Alicante, Alicante, Spain

[23] Univ Barcelona, Hosp Univ Bellvitge, Gastroenterol Dept, Hepatol Unit,IDIBELL, Barcelona, Spain

[24] Ctr Hosp Sao Joao, Gastroenterol & Hepatol Dept, Porto, Portugal

[25] Univ Copenhagen, Univ Hosp Hvidovre, Fac Hlth & Med Sci, Med Div,Gastro Unit, Copenhagen, Denmark

[26] Ctr Hosp Univ Lisboa Norte, Servi Gastroenterol & Hepatol, Hosp Santa Maria, Lisbon, Portugal

[27] Univ Autonoma Barcelona, Hosp del Mar, Gastroenterol Dept, Liver Sect, Barcelona, Spain

[28] Hosp Cent Asturias, Dept Gastroenterol, Oviedo, Spain

[29] Med Univ Vienna, Dept Internal Med 3, Div Gastroenterol & Hepatol, Vienna, Austria

[30] Univ Hosp San Cecilio, Dept Gastroenterol, Granada, Spain

[31] Aarhus Univ Hosp, Dept Hepatol & Gastroenterol, Aarhus, Denmark

[32] Univ Hosp Canary Isl, Gastroenterol Dept, Tenerife, Spain

[33] Arcispedale Santa Maria Nuova IRCCS, Unit Gastroenterol & Digest Endoscopy, Reggio Emilia, Italy

[34] Univ Milan, Dept Clin & Biomed Sci Luigi Sacco, Gastroenterol Unit, ASST Fatebenefratelli Sacco, Milan, Italy

[35] Univ Hosp Padua, Dept Surg Oncol & Gastroenterol, Multivisceral Transplant Unit, Gastroenterol, Padua, Italy

[36] Univ Alberta, Div Gastroenterol, Liver Unit, Edmonton, AB, Canada

[37] Hosp Univ Valme, CIBERehd, Unidad Hepatol, Seville, Spain

[38] Martin Luther Univ Halle Wittenberg, Dept Internal Med 1, Halle, Saale, Germany

[39] Univ Autonoma Barcelona, Digest Dis Dept, Hepatol Unit, Hosp Sabadell, Sabadell, Spain

[40] Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Badalona, Spain

[41] Univ Milan, IRCCSCa Granda Maggiore Hosp Fdn, Div Gastroenterol & Hepatol, Milan, Italy

[42] Univ Bonn, Dept Internal Med 1, Bonn, Germany

[43] Bern Univ, Dept Biomed Res, Inselspital, Hepatol, Bern, Switzerland

关键词: Cirrhosis;    Acute variceal bleeding;    Antibiotic prophylaxis;    Bacterial infection;    Respiratory infection;   

DOI  :  10.1016/j.jhep.2021.03.026

来源: Elsevier

【 摘 要 】

Background & Aims: Antibiotic prophylaxis reduces the risk of infection and mortality in patients with cirrhosis and acute variceal bleeding (AVB). This study examines the incidence of, and risk factors for, bacterial infections during hospitalization in patients with AVB on antibiotic prophylaxis. Methods: A post hoc analysis was performed using the database of an international, multicenter, observational study designed to examine the role of pre-emptive transjugular intrahepatic portosystemic shunts in patients with cirrhosis and AVB. Data were collected on patients with cirrhosis hospitalized for AVB (n = 2,138) from a prospective cohort (October 2013-May 2015) at 34 referral centers, and a retrospective cohort (October 2011-September 2013) at 19 of these centers. The primary outcome was incidence of bacterial infection during hospitalization. Results: A total of 1,656 patients out of 1,770 (93.6%) received antibiotic prophylaxis; third-generation cephalosporins (76.2%) and quinolones (19.0%) were used most frequently. Of the patients on antibiotic prophylaxis, 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 (odds ratio [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 placement (OR 1.7; 95% CI 1.2-2.4) or esophageal balloon tamponade (OR 2.4; 95% CI 1.2-4.9). Conclusion: 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. Lay summary: Bacterial infections develop during hospitalization in close to 20% of patients with acute variceal bleeding despite antibiotic prophylaxis. Respiratory bacterial infections are the most frequent and occur 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. (C) 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

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