title: Increased intestinal permeability as a predictor of bacterial infections in patients with decompensated liver cirrhosis and hemorrhage.
abstract: OBJECTIVE
  There have been no trials comparing the prophylactic effect of oral quinolone and intravenous cephalosporin antibiotics and elucidating the predictive factors for the occurrence of bacterial infections in cirrhotic patients with gastrointestinal bleeding in Asian-Pacific region.
  
  
  METHODS
  One hundred and thirteen patients with advanced liver cirrhosis and active gastrointestinal hemorrhage were enrolled in our study. The patients were randomly allocated into either the oral ciprofloxacin group (n = 50, 500 mg every 12 h) or the intravenous ceftriaxone group (n = 63, 2.0 g per day for 7 days).
  
  
  RESULTS
  Proven or possible infections were significantly more frequent in the patients in the oral ciprofloxacin group (34.0%) than the intravenous ceftriaxone group (14.3%, P = 0.002). The intestinal permeability index (IPI, mean [SD]) measured the day after admission was significantly higher in the patients with proven or possible infections (1.45 [0.96]) compared with the no infection group (0.46 [0.48], P <0.01). By multivariate analysis, oral ciprofloxacin prophylaxis and higher IPI at the time of inclusion were independent and significant predictors for proven or possible infections. By receiver operating characteristic curve analysis, the best cutoff value of IPI for the prediction of the occurrence of bacterial infection was 0.62%.
  
  
  CONCLUSIONS
  The frequency of proven or possible infections was significantly lower in the intravenous ceftriaxone group compared with the oral ciprofloxacin group. The IPI measured the day after admission is a good clinical parameter predicting the occurrence of infection in these patients.
authors.affiliation: Department of Internal Medicine, Sungkyunkwan University Kangbuk Samsung Hospital, Seoul, South Korea.
authors.forename: Byung Ik
authors.initials: BI
authors.lastname: Kim
authors.forename: Hong Joo
authors.initials: HJ
authors.lastname: Kim
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Park
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Park
authors.forename: Yong Kyun
authors.initials: YK
authors.lastname: Cho
authors.forename: Chong Il
authors.initials: CI
authors.lastname: Sohn
authors.forename: Woo Kyu
authors.initials: WK
authors.lastname: Jeon
authors.forename: Hong Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D018988:Bacterial Translocation / Q000187:drug effects*; D002511:Cephalosporins / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D002939:Ciprofloxacin / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007422:Intestines / Q000187:drug effects* / Q000382:microbiology; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010539:Permeability; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002939:Ciprofloxacin