- 期刊
Comparison of Cefazolin and Ceftriaxone as Prophylactic Antibiotic in Cirrhotic Patients with Acute Variceal Hemorrhage after Endoscopic Interventions
以Cefazolin與Ceftriaxone作為預防性抗生素在肝硬化合併急性胃食道靜脈瘤出血於內視鏡處置後的比較
摘要
研究目的：根據美國肝病研究協會(AASLD)臨床指引，在肝硬化合併消化道出血的病人應使用短期的抗生素預防如口服orfloxacin、靜脈注射ciprofloxacin或ceftriaxone。本研究的目的是比較使用第一代抗生素cefazolin與第三代抗生素ceftriaxone在肝硬化合併急性胃食道靜脈瘤出血做內視鏡處置後，作爲預防性抗生素效果。方法：此爲本醫學中心在2009年7月到2010年10月期間，橫斷面回溯性病歷回顧肝硬化合併急性胃食道靜脈瘤出血接受過內視鏡處置的病人。我們排除了一些有感染症狀，或是最近使用其他抗生素的病人。本研究的病人被分爲兩組：cefazolin組（54人，每八小時給予靜脈注射cefazolin 1克，使用二到七天），與ceftriaxone組（22人，每十二小時給予靜脈注射ceftriaxone 1克，使用二到七天）。評估指標在於比較這兩組感染的預防，住院天數，再出血的時間，與死亡。結果：總共蒐集了76個病人（男女各爲52人與24人，年齡爲9.5±14.1歲）。除了ceftriaxone組在凝血原時間較爲延長，兩組的基本的臨床與實驗室數據並無統計的差別。評估指標上，兩組在感染率(22.2% vs.27.3%, P=.639)，住院天數(11.3±11.7 vs. 13.9±11.6, P=.348)，再出血(P=.348 Log-Rank Test)，死亡(7.4%vs. 13.6%, P=.325)沒有差別。結論：本研究結果顯示在肝硬化合併急性胃食道靜脈瘤出血於內視鏡處置後使用cefazolin作爲預防性抗生素，對於減少感染，住院天數，再出血，死亡，可以獲得和ceftriaxone相同的結果。本研究的侷限在於其回溯性研究的性質與相對較小的樣本數。不過，這議題需要往後更大型的研究來闡述。
並列摘要
Background and Aims: According to American Association for the Study of Liver Diseases (AASLD) practice guidelines, Short-term antibiotic prophylaxis should be instituted in any patient with cirrhosis and gastrointestinal bleeding (GI) hemorrhage. Oral norfloxacin or intravenous ciprofloxacin and intravenous ceftriaxone are the recommended antibiotics but little has been known for intravenous cefazolin. This study aimed to compare cefazolin and ceftriaxone on the outcome of cirrhotic patients with acute variceal hemorrhage after endoscopic procedures.Methods: A cross-sectional, retrospective chart review study was conducted on cirrhotic patients with acute variceal bleeding who received endoscopic procedures in Kaohsiung Chang Gung Memorial Hospital in the periods from July 2009 to October 2010. Those patients with signs of infection, use of other kinds of antibiotics were excluded. They were then divided into two groups: cefazolin group (n=54, received intravenous Cefazolin 1g q8h for 2~7 days), and ceftriaxone group (n=22, received intravenous Ceftriaxone 1g q12h for 2~7 days). The end points were incidence of patients with infections, hospital days (began from the arrival at emergency room (ER) to the discharge day), time of rebleeding, death (died during hospitalization).Results: A total of 76 patients were enrolled (Male/Female=52/24, Age: 59.5±14.1). There were no significant differences in any of the clinical and laboratory data between cefazolin and ceftriaxone groups except for prolonged prothrombin time (12.7±1.4 vs. 16.0±6.4, P=.028). There were neither significant difference in infections rate (22.2% vs. 27.3%, P=.639), hospital days (11.3 ± 11.7 vs. 13.9 ± 11.6, P=.348), actuarial probability of remaining free of rebleeding (P=.348 by log-rank test) and mortality (7.4% vs. 13.6%, P=.325) between the two groups.Conclusion: Prophylactic intravenous cefazolin may have similar benefit as ceftriaxone in reducing infections, hospital days, rebleeding, and mortality in cirrhotic patients with acute variceal hemorrhage after endoscopic interventions. More large-scale studies are mandatory for this issue.