SAT-079-Respiratory infection in patients with cirrhosis and acute variceal bleeding on antibiotic prophylaxis: A multicenter observational study of 2138 patients

Abstract

Background and aims: Antibiotic prophylaxis is recommended to reduce the high risk of bacterial infection in patients with acute variceal bleeding (AVB). The aim of this study was to evaluate the incidence and risk factors of bacterial infection in patients with AVB receiving antibiotic prophylaxis. Method(s): Sub-analysis of a multicenter, international, observational study of 2138 patients with cirrhosis admitted for AVB from October 2011 toMay 2015 to address the efficacy of pre-emptive TIPS. We excluded patients with infection at admission (368)and those who did not received antibiotic prophylaxis (114, 5%). Finally, 1656 patients were included in the analyses. Result(s): Third generation cephalosporins (1263 patients, 76.3%)and quinolones (308 patients, 18.6%)were the main antibiotics used for prophylaxis. Bacterial infection developed in 336 out of the 1656 patients (20%): respiratory (156 patients, 46%), urinary (52, 3%), bacteriemia (34, 10%), SBP (29, 9%), cellulitis (12, 3%), others (53, 16%)and unknown (30, 9%). We specifically analyzed the risk factors of respiratory infection, the most frequent infection observed. Patients that developed respiratory infection (n = 156; 9, 4%)were similar to non-infected patients (n = 1320)regarding etiology of cirrhosis (alcohol, 52 vs. 45%), Child (B/C, 51/30 vs. 52/24%), previous antibiotic use (12 vs. 11%). Respiratory infection rates were independent of the type of antibiotic prophylaxis. Differences between groups were associated with active alcohol abuse (44 vs. 34%; p = 0.01), oro-tracheal intubation (41 vs. 17%; p = 0.001), nasogastric tube (44 vs. 30%; p = 0.001), and balloon tamponade (8 vs. 2%; p = 0, 02). In multivariate analysis, active alcohol abuse (OR 1.7; 95%CI 1.4-2), nasogastric tube (OR 1.7; 95%CI 1.2-2.4), oro-tracheal intubation (OR 3.1; 95%CI 2.1-4.3)and balloon tamponade (OR 2.6; 95%CI 1.8-5.1)were independently associated with respiratory infection. Further, in multivariate analysis, oro-tracheal intubation (OR 1.5; 95%CI 1.1-2.1)and nasogastric tube (OR 1.3; 95%CI 1.0-1.7)were also independently associated with the development of any type of bacterial infection. Conclusion(s): Five percent of patients with AVB do not receive antibiotic prophylaxis. Respiratory infection is the most common bacterial infection in patients on antibiotic prophylaxis, and its risk factors are airway manipulation and active alcohol use. Current recommendations of antibiotic prophylaxis show rather low efficacy to prevent respiratory infection in patients with AVB at high-risk.Copyright © 2019 European Association for the Study of the Liver