The role of antibiotics in upper gastrointestinal bleeding among cirrhotic patients without major complications after endoscopic hemostasis.
J Gastroenterol Hepatol. 2019 Nov 01;:
Authors: Wu CK, Yang SC, Liang CM, Li YC, Yeh WS, Tai WC, Lee CH, Yang YH, Hsu CN, Tsai TH, Chuah SK
BACKGROUND AND AIMS: Antibiotic prophylaxis should be instituted for cirrhotic patients with upper gastrointestinal bleeding (UGIB) but the benefit on compensated patients remains undetermined. We aimed to compare the clinical outcomes between cirrhotic patients without major complications with UGIB with and without antibiotic prophylaxis.
METHODS: We conducted this population-based cohort study by using Taiwanese Longitudinal Health Insurance Database 2000 (LHID 2000, between 1997 to 2013), aged 18 years or older with a hospital discharge diagnosis of cirrhosis (n=64,506), UGIB (n=7,784) and endoscopic therapy (n=2,292). After strict exclusions, 1205 patients were enrolled and were divided into antibiotic exposure (n=558) and non-exposure (n=647) groups. The outcomes were rebleeding and mortality.
RESULTS: After competing analysis adjusted by death, the rebleeding rates within 4 weeks was significant lower in patients with antibiotic prophylaxis (3.05% versus 6.03%, p= 0.0142) and those with endoscopic therapy (0.72% versus 3.09%, p=0.0033) but not significant after 3 months and onwards. Patients with characters of male gender, age>55, high CCI score≧4 and UGIB of variceal etiologies were benefited from rebleeding. The use of antibiotics did not significantly impact 6-week mortality (aHR: 1.07, 95%CI: 0.41~2.75; p=0.8943). Old age, multiple comorbidities and UGIB of variceal etiologies were risk factors of all-cause mortality.
CONCLUSIONS: Current study suggested that cirrhotic patients without major complications who suffered from UGIB were benefited by the use of antibiotics to prevent rebleeding within 4 weeks after endoscopic treatment of UGIB especially for those with age>55, high CCI score≧4 and UGIB of variceal etiologies.
PMID: 31674688 [PubMed - as supplied by publisher]