title: The effect of systemic antibiotic prophylaxis for cirrhotic patients with peptic ulcer bleeding after endoscopic interventions.
abstract: OBJECTIVE
  All previous studies reported the benefit of antibiotic prophylaxis in cirrhotic patients with either a mixture of nonvariceal and variceal bleeding or variceal bleeding alone. Reports on sole peptic ulcers bleeding are lacking. We aimed to assess the effect of antibiotic prophylaxis in cirrhotic patients with peptic ulcer bleeding after endoscopic interventions and the risk factors associated with recurrent bleeding.
  
  
  METHODS
  A cross-sectional retrospective chart review study was conducted on 148 cirrhotic patients with acute peptic ulcer hemorrhage who underwent therapeutic endoscopic procedures. Patients who received prophylactic intravenous ceftriaxone were classified as group A (n = 38) and those who did not receive antibiotics were classified as group B (n = 110). The outcomes were prevention of infection, length of hospital stay, time of rebleeding, and death.
  
  
  RESULTS
  More patients suffered from recurrent bleeding and infection in group B than those in group A (28.2 vs. 5.3 %; p = 0.003, and 26.4 vs. 10.5 %; p = 0.043, respectively). The risk factors associated with recurrent bleeding were being male (OR = 3.4; p = 0.024), those with advanced stage of cirrhosis with Child-Pugh's class C (OR = 3.8; p < 0.001), and those without antibiotic prophylaxis (OR = 8.9; p = 0.003). The observed 30-day survival was virtually identical for both groups (p = 0.279).
  
  
  CONCLUSIONS
  Antibiotic prophylaxis in cirrhotic patients after endoscopic interventions for acute peptic ulcer hemorrhage reduced infections and decreased rebleeding. Male gender, cirrhosis Child-Pugh's class C, and no antibiotic prophylaxis were independent predictors of recurrent bleeding. Further studies should be directed to explore ways to improve the overall outcome of these patients.
authors.affiliation: Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, 123, Ta-Pei Road, Niao-sung Hsiang, Kaohsiung, 833, Taiwan.
authors.forename: Shih-Cheng
authors.initials: SC
authors.lastname: Yang
authors.affiliation: Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, 123, Ta-Pei Road, Niao-sung Hsiang, Kaohsiung, 833, Taiwan.
authors.forename: Keng-Liang
authors.initials: KL
authors.lastname: Wu
authors.affiliation: Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, 123, Ta-Pei Road, Niao-sung Hsiang, Kaohsiung, 833, Taiwan.
authors.forename: Jing-Hung
authors.initials: JH
authors.lastname: Wang
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chen-Hsiang
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, 123, Ta-Pei Road, Niao-sung Hsiang, Kaohsiung, 833, Taiwan.
authors.forename: Yuan-Hung
authors.initials: YH
authors.lastname: Kuo
authors.affiliation: Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, 123, Ta-Pei Road, Niao-sung Hsiang, Kaohsiung, 833, Taiwan.
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Tai
authors.affiliation: Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, 123, Ta-Pei Road, Niao-sung Hsiang, Kaohsiung, 833, Taiwan.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, 123, Ta-Pei Road, Niao-sung Hsiang, Kaohsiung, 833, Taiwan.
authors.forename: Shue-Shian
authors.initials: SS
authors.lastname: Chiou
authors.affiliation: Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, 123, Ta-Pei Road, Niao-sung Hsiang, Kaohsiung, 833, Taiwan.
authors.forename: Sheng-Nan
authors.initials: SN
authors.lastname: Lu
authors.affiliation: Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, 123, Ta-Pei Road, Niao-sung Hsiang, Kaohsiung, 833, Taiwan.
authors.forename: Tsung-Hui
authors.initials: TH
authors.lastname: Hu
authors.affiliation: Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, 123, Ta-Pei Road, Niao-sung Hsiang, Kaohsiung, 833, Taiwan.
authors.forename: Chi-Sin
authors.initials: CS
authors.lastname: Changchien
authors.affiliation: Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, 123, Ta-Pei Road, Niao-sung Hsiang, Kaohsiung, 833, Taiwan. chuahsk@seed.net.tw.
authors.forename: Seng-Kee
authors.initials: SK
authors.lastname: Chuah
keywords: Antibiotic prophylaxis; Bacterial infections; Cirrhosis; Peptic ulcers; Rebleeding; Upper gastrointestinal bleeding