Patients with liver disease admitted with variceal hemorrhage were often not prescribed antimicrobial therapy to reduce the risk of bacterial infection. Our results imply that published practice guidelines are not being consistently observed. A large-scale, well-designed study with mortality outcome may be required […]
According to present clinical practice guidelines, gaps in antimicrobial therapy were observed in our patient population at risk of infection following variceal hemorrhage. Because many of the patients reviewed were hospitalized before most of the recommendations were published and widely disseminated, our results may not actually be an example of how clinical practice guidelines often have limited effect on changing physician behaviour . While it appears that adherence to guidelines […]
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 […]
The source of hemorrhage on admission was primarily variceal bleed (74.5%) and largely managed by band ligation and octreotide (42.5%) or octreotide alone (29%). The majority underwent endoscopy for diagnosis and management (91%). Many had physical findings of ascites (76.5%) and nearly one-half at some point during admission developed symptoms consistent with encephalopathy. The average length of hospitalization was almost two weeks. Seventeen patients did not survive to discharge.
Of the 205 patients screened, 98 were included in the present analysis. Ninety-two patients initially identified as having suspected variceal hemorrhage (International Classification of Diseases, 10th edition code) did not in fact have diagnosed liver disease or varices on examination of their […]
A retrospective chart review was conducted at a major tertiary care centre in Canada. Patients admitted to hospital with suspected variceal hemorrhage during a 33-month period between January 2001 and September 2003 were evaluated for inclusion. The study received university and hospital ethics approval before initiation.
Patients with liver disease were included if they had evidence of bleeding varices by upper endoscopy performed at hospital admission. Cirrhosis patients admitted and […]
A number of studies have evaluated the role of antimicrobials for the prevention of bacterial infections in patients with liver disease and GI bleed. Meta-analyses of these data demonstrate that single-dose or short-course antibiotic therapy decreases infections and reduces 19-day mortality. No specific regimen appears more efficacious when the limited number of comparison trials are evaluated, although the fluoroquinolones are the most studied. Based on these data, a number of professional […]
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