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Prophylactic Antibiotic Use and Clinical Outcomes in Patients With Child-Pugh A Cirrhosis and Acute Variceal
Jiajia He1, Ju Huang1, Guofeng Liu1
1From the Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, China, scu.edu.cn.
Insights
Prophylactic antibiotics did not significantly reduce treatment failure or mortality in Child-Pugh class A patients with acute variceal bleeding (AVB). Routine antibiotic use may not be necessary for this low-risk cirrhotic group.
Area of Science:
- Hepatology
- Gastroenterology
- Infectious Disease Management
Background:
- Acute variceal bleeding (AVB) in cirrhosis patients necessitates interventions to prevent complications.
- Child-Pugh class A cirrhosis indicates a lower risk profile for mortality and treatment failure.
- Previous studies suggested prophylactic antibiotics reduce mortality in cirrhosis with AVB.
Purpose of the Study:
- To investigate the association between prophylactic antibiotic use and outcomes in Child-Pugh class A patients with AVB.
- To determine if antibiotics impact treatment failure, mortality, or infection rates in this specific patient cohort.
Main Methods:
- Retrospective analysis of 237 Child-Pugh class A patients with AVB.
- Comparison between patients receiving prophylactic antibiotics (Group A, n=117) and those not (Group B, n=120).
- Evaluation of 5-day treatment failure, 6-week mortality, nosocomial infections, and 1-year cumulative mortality.
Main Results:
- No significant difference in 5-day treatment failure rates between Group A (8.5%) and Group B (6.7%), p=0.63.
- No significant difference in 6-week mortality between Group A (1.71%) and Group B (0%), p=0.24.
- Comparable incidence of nosocomial infections and 1-year cumulative mortality between the groups.
Conclusions:
- Prophylactic antibiotic use showed no association with reduced 5-day treatment failure or 6-week mortality in Child-Pugh A patients with AVB.
- Routine prophylactic antibiotic administration may not be essential for this patient population.
- Further research could explore specific subgroups or alternative prophylactic strategies.
Background & Aims:
Prophylactic use of antibiotics was found to decrease mortality in patients with cirrhosis and acute variceal bleeding (AVB). Patients with Child A cirrhosis have a low risk of treatment failure and mortality. The present study was designed to investigate the association between antibiotics and Child-Pugh A patients with AVB.
Methods:
This retrospective analysis was conducted on Child-Pugh class A cirrhotic patients presenting with AVB at West China Hospital between January 2016 and November 2022. The outcome indicators evaluated in this study include the rate of treatment failure within five days, mortality within 6 weeks, incidence of nosocomial infections, and 1-year cumulative mortality.
Results:
This study ultimately enrolled 237 patients. The day of patients' admission was defined as Day 0. A total of 117 patients received prophylactic use of antibiotics on Days 0-1 (Group A), and 120 patients did not receive antibiotics on Days 0-1 (Group B). Baseline characteristics were well-balanced between the two groups. The 5-day treatment failure was 8.5% in Group A and 6.7% in Group B (p = 0.63). The 6-week mortality was 1.71% in Group A and 0% in Group B (p = 0.24). The incidence of nosocomial infection (5.98% vs. 6.67%, p = 1.00) and 1-year cumulative mortality (4.81% vs. 1.89%, p = 0.40) was comparable between the two groups.
Conclusions:
The antibiotics' prophylactic use was not associated with 5-day treatment failure or 6-week mortality. Prophylactic use of antibiotics may not be routinely necessary in patients with Child A cirrhosis and AVB.
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