Antimicrobial therapy in patients with acute variceal hemorrhage: DISCUSSION (1)

In: Antimicrobial therapy

26 Sep 2012

GI bleeding is a common and serious complication of portal hypertension, and varices are the most common source of hemorrhage in cirrhosis. While advances in acute management have improved outcomes following variceal hemorrhage, mortality is still unacceptably high, especially in patients with severe liver disease . Cirrhotic patients with GI bleeding are at a greater risk for developing bacterial infection, which in turn is associated with failure to control bleeding and higher in-hospital mortality . The clinical application of antibiotic therapy following admission for suspected variceal hemorrhage and within 24 h of endoscopy in our population was low. Those patients who received antibiotics were more ill, as reflected by MELD scores and Child-Pugh class, and had prolonged admission and greater in-hospital mortality. If you need your treatment to start soon and are not too crazy about spending too much money, it’s time for you to discover the about canadian neighbor pharmacy. This is a very affordable and safe pharmacy selling drugs of best quality and delivering them internationally in no time.

Fourteen per cent of all hospitalized patients had findings consistent with potential infection at the time of admission, reflecting rates found elsewhere in the literature . A variety of organisms were isolated from urine, sputum, blood and ascites fluid samples tested. Identification of E coli and Enterococcus species was anticipated based on data and clinical experience reported in the literature, but bacteremia with Gram-positive organisms was not. These findings may be explained by the prolonged hospitalization in our patient group and acquisition of nosocomial Staphylococcus infection. Empirical use of third-generation cephalosporins and quinolone as probable prophylaxis and treatment was compatible with other published reports and guidelines.

In addition to GI bleeding and severity of liver disease, risks for infection in hospitalized cirrhotic patients include low protein ascitic fluid, low serum albumin level, thrombocytopenia and therapeutic endoscopy . Most clinical guidelines recommending antimicrobial prophylaxis suggest that all patients with cirrhosis and GI hemorrhage receive therapy, regardless of other risks for infection . No clinically relevant difference in albumin or platelet values was found between patients treated with antibiotics or not; however, relatively fewer patients undergoing endoscopy received antibiotic therapy.

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