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Limited effects of antibiotic prophylaxis in patients with Child–Pugh class A/B cirrhosis and upper gastrointestinal bleeding

Current guidelines recommend antibiotic prophylaxis for all patients with various degrees of cirrhosis and upper gastrointestinal (UGI) bleeding. This study assessed the need for antibiotic prophylaxis in patients with low Child–Pugh scores. We retrospectively screened all patients with cirrhosis wh...

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Autores principales: Chang, Te-Sheng, Tsai, Ying-Huang, Lin, Yi-Heng, Chen, Chun-Hsien, Lu, Chung-Kuang, Huang, Wen-Shih, Yang, Yao-Hsu, Chen, Wei-Ming, Hsieh, Yung-Yu, Wu, Yu-Chih, Tung, Shui-Yi, Huang, Yen-Hua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034903/
https://www.ncbi.nlm.nih.gov/pubmed/32084186
http://dx.doi.org/10.1371/journal.pone.0229101
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author Chang, Te-Sheng
Tsai, Ying-Huang
Lin, Yi-Heng
Chen, Chun-Hsien
Lu, Chung-Kuang
Huang, Wen-Shih
Yang, Yao-Hsu
Chen, Wei-Ming
Hsieh, Yung-Yu
Wu, Yu-Chih
Tung, Shui-Yi
Huang, Yen-Hua
author_facet Chang, Te-Sheng
Tsai, Ying-Huang
Lin, Yi-Heng
Chen, Chun-Hsien
Lu, Chung-Kuang
Huang, Wen-Shih
Yang, Yao-Hsu
Chen, Wei-Ming
Hsieh, Yung-Yu
Wu, Yu-Chih
Tung, Shui-Yi
Huang, Yen-Hua
author_sort Chang, Te-Sheng
collection PubMed
description Current guidelines recommend antibiotic prophylaxis for all patients with various degrees of cirrhosis and upper gastrointestinal (UGI) bleeding. This study assessed the need for antibiotic prophylaxis in patients with low Child–Pugh scores. We retrospectively screened all patients with cirrhosis who underwent upper endoscopies for UGI bleeding in a referral hospital in Taiwan between 2003 and 2014, from which 913 patients were enrolled after excluding patients with active bacterial infections, recent antibiotic use, early death, and Child–Pugh class C cirrhosis. Among them, 73 (8%) received prophylactic antibiotics, and 45 (4.9%) exhibited 14-day bacterial infection. Neither Child–Pugh score nor model for end stage liver disease score were optimal for predicting bacterial infection because their areas under the curves were 0.610 (95% confidence interval [CI]: 0.529–0.691) and 0.666 (95% CI: 0.591–0.742), respectively. Antibiotic prophylaxis did not reduce the risks of 14-day bacterial infection (relative risk [RR]: 0.932, 95% CI: 0.300–2.891, P = 0.902), 14-day rebleeding (RR: 0.791, 95% CI: 0.287–2.181, P = 0.650), or 42-day mortality (RR: 2.710, 95% CI: 0.769–9.524, P = 0.121). The results remained similar after propensity score adjustment. On-demand antibiotic treatment might suffice for patients with Child–Pugh class A/B cirrhosis and UGI bleeding.
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spelling pubmed-70349032020-02-27 Limited effects of antibiotic prophylaxis in patients with Child–Pugh class A/B cirrhosis and upper gastrointestinal bleeding Chang, Te-Sheng Tsai, Ying-Huang Lin, Yi-Heng Chen, Chun-Hsien Lu, Chung-Kuang Huang, Wen-Shih Yang, Yao-Hsu Chen, Wei-Ming Hsieh, Yung-Yu Wu, Yu-Chih Tung, Shui-Yi Huang, Yen-Hua PLoS One Research Article Current guidelines recommend antibiotic prophylaxis for all patients with various degrees of cirrhosis and upper gastrointestinal (UGI) bleeding. This study assessed the need for antibiotic prophylaxis in patients with low Child–Pugh scores. We retrospectively screened all patients with cirrhosis who underwent upper endoscopies for UGI bleeding in a referral hospital in Taiwan between 2003 and 2014, from which 913 patients were enrolled after excluding patients with active bacterial infections, recent antibiotic use, early death, and Child–Pugh class C cirrhosis. Among them, 73 (8%) received prophylactic antibiotics, and 45 (4.9%) exhibited 14-day bacterial infection. Neither Child–Pugh score nor model for end stage liver disease score were optimal for predicting bacterial infection because their areas under the curves were 0.610 (95% confidence interval [CI]: 0.529–0.691) and 0.666 (95% CI: 0.591–0.742), respectively. Antibiotic prophylaxis did not reduce the risks of 14-day bacterial infection (relative risk [RR]: 0.932, 95% CI: 0.300–2.891, P = 0.902), 14-day rebleeding (RR: 0.791, 95% CI: 0.287–2.181, P = 0.650), or 42-day mortality (RR: 2.710, 95% CI: 0.769–9.524, P = 0.121). The results remained similar after propensity score adjustment. On-demand antibiotic treatment might suffice for patients with Child–Pugh class A/B cirrhosis and UGI bleeding. Public Library of Science 2020-02-21 /pmc/articles/PMC7034903/ /pubmed/32084186 http://dx.doi.org/10.1371/journal.pone.0229101 Text en © 2020 Chang et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Chang, Te-Sheng
Tsai, Ying-Huang
Lin, Yi-Heng
Chen, Chun-Hsien
Lu, Chung-Kuang
Huang, Wen-Shih
Yang, Yao-Hsu
Chen, Wei-Ming
Hsieh, Yung-Yu
Wu, Yu-Chih
Tung, Shui-Yi
Huang, Yen-Hua
Limited effects of antibiotic prophylaxis in patients with Child–Pugh class A/B cirrhosis and upper gastrointestinal bleeding
title Limited effects of antibiotic prophylaxis in patients with Child–Pugh class A/B cirrhosis and upper gastrointestinal bleeding
title_full Limited effects of antibiotic prophylaxis in patients with Child–Pugh class A/B cirrhosis and upper gastrointestinal bleeding
title_fullStr Limited effects of antibiotic prophylaxis in patients with Child–Pugh class A/B cirrhosis and upper gastrointestinal bleeding
title_full_unstemmed Limited effects of antibiotic prophylaxis in patients with Child–Pugh class A/B cirrhosis and upper gastrointestinal bleeding
title_short Limited effects of antibiotic prophylaxis in patients with Child–Pugh class A/B cirrhosis and upper gastrointestinal bleeding
title_sort limited effects of antibiotic prophylaxis in patients with child–pugh class a/b cirrhosis and upper gastrointestinal bleeding
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034903/
https://www.ncbi.nlm.nih.gov/pubmed/32084186
http://dx.doi.org/10.1371/journal.pone.0229101
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