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The impact of intravenous cefazolin to the outcomes of cirrhotic patients with esophageal varices bleeding

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DOI: 10.4236/ojgas.2013.33030    2,351 Downloads   3,498 Views   Citations

ABSTRACT

Background and Method: Prophylatic antibiotics in cirrhotic patients with acute esophageal varices (EV) bleeding has been shown to increase survival and decrease the rate of bacterial infections and recurrent bleeding. This study aimed to compare the outcome of intravenous cefazolin, a first-generation cephalosporin, in the cirrhotic patients with EV bleeding. 92 consecutive cirrhotic patients with EV bleeding but without evidence of infection were retrospectively analyzed from December 2006 to February 2009, and 50 with cefazolin prophylaxis and 42 without antibiotic prophylaxis were enrolled in the antibiotic prophylaxis group and control group respectively. The outcomes were compared between both groups. Results: The incidence of infection was significantly lesser in the antibiotic prophylaxis group than that of the control group (6% vs. 33.3%, P < 0.05). The incidence of recurrent EV bleeding (6% vs. 9.5%) and mortality (4% vs. 7.1%) showed no significant difference between both groups. Mean length of hospital stay was shorter, but insignificant in the antibiotic prophylaxis group when compared with control group (6.6 vs. 7.8 days). Conclusion: Intravenous cefazolin can effectively reduce the rate of infection in cirrhotic patients with acute EV bleeding, but cannot significant benefit for preventing recurrent EV bleeding and mortality within 10 days after initial bleeding. 

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Lee, S. , Lee, T. , Yang, S. , Ko, C. , Yeh, H. and Chang, C. (2013) The impact of intravenous cefazolin to the outcomes of cirrhotic patients with esophageal varices bleeding. Open Journal of Gastroenterology, 3, 190-195. doi: 10.4236/ojgas.2013.33030.

References

[1] Lee, S.W., Lee, T.Y., Chang, C.S., Ko, C.W., Yeh, H.Z. and Yang, S.S. (2010) Independent factors associated with early outcome in Chinese cirrhotic patients after cessation of initial esophageal variceal hemorrhage. Journal of Clinical Gastroenterology, 44, e123-e127.
[2] Rajkovic, I.A. and Williams, R. (1986) Abnormalities of neutrophil phagocytosis, intracellular killing, and metabolic activity in alcoholic liver cirrhosis and hepatitis. Hepatology, 6, 252-262. doi:10.1002/hep.1840060217
[3] Garcia-Tsao, G., Lee, F.Y., Barden, G.E., Cartun, R. and West, B. (1995) Bacterial translocation to mesenteric lymph nodes is increased in cirrhotic rats with ascites. Gastroenterology, 108, 1835-1841. doi:10.1016/0016-5085(95)90147-7
[4] Bleichner, G., Boulanger, R., Squara, P., Sollet, J.P. and Parent, A. (1986) Frequency of infections in cirrhotic patients presenting with acute gastrointestinal haemorrhage. British Journal of Surgery, 73, 724-726. doi:10.1002/bjs.1800730916
[5] Goulis, J., Armonis, A., Patch, D., Sabin, C., Greenslade, L. and Burroughs, A.K. (1998) Bacterial infection is independently associated with failure to control bleeding in cirrhotic patients with gastrointestinal hemorrhage. Hepatology, 27, 1207-1212. doi:10.1002/hep.510270504
[6] Bernard, B., Cadranel, J.F., Valla, D., Sabin, C., Greenslade, L. and Burroughs, A.K. (1995) Prognostic significance of bacterial infection in bleeding cirrhotic patients: a prospective study. Gastroenterology, 108, 1828-1034. doi:10.1016/0016-5085(95)90146-9
[7] Lee, S.W., Lee, T.Y. and Chang, C.S. (2009) Independent factors associated with recurrent bleeding in cirrhotic patients with esophageal variceal hemorrhage. Digestive Diseases and Sciences, 54, 1128-1134. doi:10.1007/s10620-008-0454-0
[8] Rimola, A., Bory, F., Teres, J., Perez-Ayuso, R.M., Arroyo, V. and Rodes, J. (1985) Oral, nonabsorbable antibiotics prevent infection in cirrhotics with gastrointestinal hemorrhage. Hepatology, 5, 463-467. doi:10.1002/hep.1840050320
[9] Soriano, G., Guarner, C., Tomas, A., Villanueva, C., Torras, X., Gonzalez, D., et al. (1992) Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage. Gastroenterology, 103, 1267-1272.
[10] Blaise, M., Pateron, D., Trinchet, J.C., Levacher, S., Beaugrand, M. and Pourriat, J.L. (1994) Systemic antibiotic therapy prevents bacterial infections in cirrhotic patients with gastrointestinal hemorrhage. Hepatology, 20, 34-38. doi:10.1002/hep.1840200107
[11] Hsieh, W.J., Lin, H.C., Hwang, S.J., Hou, M.C., Lee, F.Y. and Chang, F.Y. (1998) The effect of ciprofloxacin in the prevention of bacterial infection in patients with cirrhosis after upper gastrointestinal bleeding. American Journal of Gastroenterology, 93, 962-966. doi:10.1111/j.1572-0241.1998.00288.x
[12] Fernandez, J., Ruiz del Arbol, L., Gomez, C., Durandez, R., Serradilla, R., Guarner, C., et al. (2006) Norfloxacin vs ceftriaxone in the prophylaxis of infections in patients with advanced cirrhosis and hemorrhage. Gastroenterology, 131, 1049-1056. doi:10.1053/j.gastro.2006.07.010
[13] Garcia-Tsao, G., Sanyal, A.J., Grace, N.D. and Carey, W. (2007) Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology, 46, 922-993. doi:10.1002/hep.21907
[14] Ortiz, J., Vila, M.C., Soriano, G., Minana, J., Gana, J., Mirelis, B., et al. (1999) Infections caused by Escherichia coli resistant to norfloxacin in hospitalized cirrhotic patients. Hepatology, 29, 1064-1069. doi:10.1002/hep.510290406
[15] Castellote, J., Xiol, J., Rota Roca, R. and Fernandez Esparrach, G. (1994) Spontaneous bacterial peritonitis and empyema by Escherichia coli resistant to norfloxacin in a patient on selective intestinal decontamination with norfloxacin. Journal of Hepatology, 20, 436. doi:10.1016/S0168-8278(94)80022-7
[16] Zacharof, A.K., Petrogiannopoulos, C., Flevaris, C. and Deliousis, A. (1997) Ciprofloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage. Journal of Hepatology, 26, 101.
[17] Hou, M.C., Lin, H.C., Liu, T.T., Kuo, B.I., Lee, F.Y., Chang, F.Y. and Lee, S.D. (2004) Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: A randomized trial. Hepatology, 39, 746-753. doi:10.1002/hep.20126
[18] Bernard, B., Grange, J.D., Khac, E.N., Amiot, X., Opolon, P. and Poynard, T. (1999) Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: A meta-analysis. Hepatology, 29, 1655-1661. doi:10.1002/hep.510290608

  
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