Antimicrobial therapy in patients with acute variceal hemorrhage.
BACKGROUND
Acute variceal hemorrhage is a serious complication of liver disease and hospital outcome is closely related to infection. Patients with cirrhosis are at greater risk for developing bacterial infection, which is associated with failure to control bleeding and higher rates of hospital mortality. Many clinical practice guidelines endorse antimicrobial prophylaxis as standard of care for cirrhotic patients.


OBJECTIVE
The present study was performed to characterize the use of antimicrobial therapy for patients hospitalized with acute variceal hemorrhage.


METHODS
Medical records of 98 patients hospitalized with suspected variceal hemorrhage were retrospectively reviewed.


RESULTS
One-half of the patients received antimicrobials at any time during their hospital admission, and in very few (24%) could prescribed therapy be considered prophylactic. Seventy-seven per cent of patients undergoing endoscopy did not receive an antimicrobial within 24 h of the procedure. Those who received antimicrobial therapy had more severe liver disease (model for end-stage liver disease scores of 19.5 +/- 10 versus 12.9 +/- 8, P< 0.05; Child-Pugh class C 78% versus 65%, not significant) and worse in-hospital outcome (length of stay 17 versus 6.5 days, P<0.05; mortality 15 versus two, P< 0.05). Cephalosporins were the most widely prescribed agents (45%), followed by fluoroquinolone (40%). Regimens ranged in length from single-dose administration to two weeks.


CONCLUSIONS
Patients with liver disease admitted with variceal hemorrhage were often not prescribed antimicrobial therapy to reduce the risk of bacterial infection. These results imply that published practice guidelines are not being consistently observed. A large, well-designed study with mortality outcome may be required for clinical guidelines to be successfully implemented in practice.
Wilbur
Kerry
K
CSU Pharmaceutical Sciences, Vancouver General Hospital, 855 West 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada. kerry.wilbur@vch.ca
Sidhu
Kiran
K
D000208:Acute Disease; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008107:Liver Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D000890:Anti-Infective Agents