Compliance with Antibiotic Prophylaxis Guidelines in Patients with Acute Variceal Bleeding

Hui-Chen Lin ； Gin-Ho Lo ； Daw-Shyong Perng ； Chih-Wen Lin ； Chi-Ming Tai

《E-Da Medical Journal》 3卷1期 (2016/03) Pp. 9-16

https://doi.org/10.6966/EDMJ.201603_3(1).0002

摘要

Background: Bacterial infections are frequently encountered in cirrhotic patients with gastrointestinal hemorrhage. Antibiotic prophylaxis is regarded by practice guidelines as an integral part of therapy for cirrhotic patients presenting with upper gastrointestinal bleeding. Objectives: The study aimed at comparing the compliance of our hospital staff between 2 study patient cohorts and assessing whether use of antibiotic prophylaxis may decrease the incidence of infections and variceal rebleeding. Methods: Cirrhotic patients presenting with variceal bleeding at E-Da Hospital during two time periods (i.e., 2005-2006 and 2012) without bacterial infections were retrospectively reviewed to evaluate the compliance with the guidelines on antibiotic prophylaxis and its impact on rebleeding. Results: The 2005-2006 cohort comprised 90 patients and the 2012 cohort comprised 113 patients. In the 2005-2006 cohort, only 6 of 90 (6.7%) patients received prophylactic antibiotics, whereas 94 of 113 (83.2%) patients in the 2012 cohort received prophylactic antibiotics (p＜ 0.05). The incidence of bacterial infections was 19% among patients without receiving prophylactic antibiotics and 24% in patients receiving prophylactic antibiotics (p ＞ 0.05). The rebleeding rate was 14% among patients receiving prophylactic antibiotics and 6% among patients without using prophylactic antibiotics (p= 0.54). The survival at discharge was 88% among patients with prophylactic antibiotics and 91% in those without (p=0.45). Conclusions: The compliance with guidelines on antibiotic prophylaxis in patients with acute variceal bleeding has increased significantly in recent years. However, the use of antibiotic prophylaxis did not appear to reduce infection, rebleeding or mortality in patients receiving banding ligation instead of sclerotherapy.

關鍵字

banding ligation ； antibiotic prophylaxis ； variceal rebleeding