Incidence of bacterial infections in patients with cirrhosis and acute variceal bleeding (AVB)

Background and Aim: Bacterial infection is common after acute variceal bleed (AVB) in patient with cirrhosis and associated with higher re-bleed and mortality rate. Antibiotics prophylaxis with ceftriaxone is recommended after AVB. Aim of this study was to evaluate incidence of bacterial infection in patient with cirrhosis after AVB during hospital stay even after antibiotic prophylaxis. Methods: Retrospective analysis of data of patients with cirrhosis and AVB who were on antibiotics from day 1 of admission was done. All patients with variceal bleed were treated with endoscopic variceal ligation or glue injection and were given vasoactive drugs, proton pump inhibitor and antibiotics for 5 days. Results: Consecutive two hundred patients were analysed. Mean age was 53±14 yrs, M:F-161:39, Child’s class A:B:C:37:121:42.Etiology of cirrhosis was NASH related in 31%(n=61) and 18%(n=35) were alcohol related. All patients received antibiotics belonging to cephalosporin group (88%) [ceftriaxone, n=122(61%), cefoperazone and sulbactem, n=54(27%)] and others (quinolones and others n=24(12%)]. Twenty-six (13%) developed infections [spontaneous bacterial peritonitis(n=7,3.5%), chest infection(n=11,5.5%) and urinary infection(n=8,4%)]. Patients who developed infections had higher CTP score (9.4±1.5 vs 7.9±1.8,p=0.001), more days of hospital stay (7±6 vs 4.5±4.0 days,p=0.06), blood transfusion (2.1±1.9 vs 1.1±1.3 units, p=0.001) and repeat endoscopy to control bleed(46% vs 9%,p=0.001).Patients who received cephalosporin group of antibiotics developed less infections compared to quinolones or other group of drugs(n=16,9% vs n=10,41%,p=0.001).Twelve patients(6%) died during hospital stay. Patients who developed infection died more compared to those who did not (27% vs 2%, p=0.001). Conclusion: 13% developed infections even after antibiotics prophylaxis in AVB. Patients, who had advanced liver disease, require more transfusion; received non cephalosporin group of antibiotics and repeat endoscopy to control bleed developed more infections and increased mortality.