Surgical Endoscopy

, Volume 25, Issue 9, pp 2911–2918 | Cite as

The effects of cefazolin on cirrhotic patients with acute variceal hemorrhage after endoscopic interventions

  • Huang-Wei Xu
  • Jing-Houng Wang
  • Moan-Shane Tsai
  • Keng-Liang Wu
  • Shue-Shian Chiou
  • Chi-Sin Changchien
  • Tsung Hui Hu
  • Sheng-Nan Lu
  • Seng-Kee Chuah
Article

Abstract

Background

The American Association for the Study of Liver Diseases (AASLD) guidelines recommend that antibiotic prophylaxis should be instituted in any patient with cirrhosis and gastrointestinal hemorrhage, and that oral norfloxacin, intravenous ciprofloxacin, and ceftriaxone are preferable. However, the antimicrobial spectrum of the first generation of cephalosporins (cefazolin) covers a wide range of bacteria species, including community-acquired strains of Escherichia coli and Klebsiella pneumoniae, but their efficacy as prophylactic antibiotics in cirrhotic patients with acute hemorrhage was seldom warranted in the literature. This study aimed to explore the effects of cefazolin on the outcome of cirrhotic patients with acute variceal hemorrhage after endoscopic interventions.

Methods

A cross-sectional, retrospective chart review study was conducted on cirrhotic patients with acute variceal hemorrhage who underwent endoscopic procedures in a medical center. Cirrhotic patients who did not receive antibiotics were classified as group A (n = 63) while patients who received intravenous cefazolin 1 g q8 h for 2–7 days were classified as group B (n = 50). The end points were the prevention of infection, length of hospital stay, time of rebleeding, and death.

Results

A total of 113 patients were studied (male/female: 82/31; age: 56.8 ± 13.5 years). The incidence of infection (including proven infections) and bacteremia were significantly lower in group B patients (38.1% vs. 16.0%, P = 0.010; 17.5% vs. 4.0%, P = 0.026; 9.5% vs. 0%, P = 0.033, respectively). The no prophylactic antibiotics treatment was the independent risk factor. There was no significant difference between the two groups with respect to the source of bleeding, type of endoscopic intervention, length of hospital stay, and mortality. Actuarial probability of remaining free of early rebleeding (<7 days) was P = 0.105 by log-rank test for all cirrhosis patients and P = 0.085 for Child-Pugh class A patients.

Conclusions

The use of cefazolin in cirrhotic patients after endoscopic interventions for acute variceal hemorrhage reduced infections. A trend of actuarial probability of remaining free of early rebleeding (<7 days) was observed, especially in Child-Pugh class A patients. This study may be hampered by the small sample size and more large-scale studies are mandatory.

Keywords

Cefazolin Cirrhosis Variceal hemorrhage Bacterial infections Rebleeding 

References

  1. 1.
    Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L (2002) Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding. Cochrane Database Syst Rev 2: CD002907Google Scholar
  2. 2.
    Soriano G, Guarner C, Tomas A, Villanueva C, Torras X, González D, Sainz S, Anguera A, Cussó X, Balanzó J (1992) Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage. Gastroenterology 103:1267–1272PubMedGoogle Scholar
  3. 3.
    Pauwels A, Mostefa-Kara N, Debenes B, Degoutte E, Levy VG (1996) Systemic antibiotic prophylaxis after gastrointestinal hemorrhage in cirrhotic patients with a high risk of infection. Hepatology 24:802–806PubMedGoogle Scholar
  4. 4.
    Bernard B, Grange JD, Khac EN, Amiot X, Opolon P, Poynard T (1999) Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology 29:1655–1661PubMedCrossRefGoogle Scholar
  5. 5.
    Fernandez J, Navasa M, Gomez J, Colmenero J, Vila J, Arroyo V, Rodes J (2002) Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 35:140–148PubMedCrossRefGoogle Scholar
  6. 6.
    Rimola A, Bory F, Teres J, Perez-Ayuso RM, Arroyo V, Rodes J (1985) Oral, nonabsorbable antibiotics prevent infection in cirrhotics with gastrointestinal hemorrhage. Hepatology 5:463–467PubMedCrossRefGoogle Scholar
  7. 7.
    Blaise M, Pateron D, Trinchet JC, Levacher S, Beaugrand M, Pourriat JL (1994) Systemic antibiotic therapy prevents bacterial infection in cirrhotic patients with gastrointestinal hemorrhage. Hepatology 20:34–38PubMedCrossRefGoogle Scholar
  8. 8.
    Hsieh WJ, Lin HC, Hwang SJ, Hou MC, Lee FY, Chang FY, Lee SD (1998) The effect of ciprofloxacin in the prevention of bacterial infection in patients with cirrhosis after upper gastrointestinal bleeding. Am J Gastroenterol 93:962–966PubMedCrossRefGoogle Scholar
  9. 9.
    Fernandez J, Del Arbol LR, Gomez C, Durandez R, Serradilla R, Guarner C, Planas R, Arroyo V, Navasa M (2006) Norfloxacin versus ceftriaxone in the prophylaxis of infections in patients with advanced cirrhosis and hemorrhage. Gastroenterology 131:1049–1056PubMedCrossRefGoogle Scholar
  10. 10.
    Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W (2007) Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 46:922–938PubMedCrossRefGoogle Scholar
  11. 11.
    Bergeron MG, Brusch JL, Barza M, Weinstein L (1973) Bactericidal activity and pharmacology of cefazolin. Antimicrob Agents Chemother 4:396–401PubMedGoogle Scholar
  12. 12.
    Hung CH, Lu SN, Wang JH, Lee CM, Chen TM, Tung HD, Chen CH, Huang WS, Changchien CS (2003) Correlation between ultrasonographic and pathologic diagnoses of hepatitis B and C virus-related cirrhosis. J Gastroenterol 38:202–203CrossRefGoogle Scholar
  13. 13.
    Pugh RN, Murray-Lyon IM, Dawson JL, Peitroni MC, Williams R (1973) Transection of the esophagus for bleeding esophageal varices. Br J Surg 60:646–649PubMedCrossRefGoogle Scholar
  14. 14.
    Koulaouzidis A, Bhat S, Saeed AA (2009) Spontaneous bacterial peritonitis. World J Gastroenterol 15:1042–1049PubMedCrossRefGoogle Scholar
  15. 15.
    Borzio M, Salerno F, Piantoni L, Cazzaniga M, Angeli P, Bissoli F, Boccia S, Colloredo-Mels G, Corigliano P, Fornaciari G, Marenco G, Pistarà R, Salvagnini M, Sangiovanni A (2001) Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis 33:41–48PubMedCrossRefGoogle Scholar
  16. 16.
    Soares-Weiser K, Brezis M, Tur-Kaspa R, Paul M, Yahav J, Leibovici L (2003) Antibiotic prophylaxis of bacterial infections in cirrhotic inpatients: a meta-analysis of randomized controlled trials. Scand J Gastroenterol 38:193–200PubMedCrossRefGoogle Scholar
  17. 17.
    Thalheimer U, Triantos CK, Samonakis DN, Patch D, Burroughs AK (2005) Infection, coagulation, and variceal bleeding in cirrhosis. Gut 54:556–563PubMedCrossRefGoogle Scholar
  18. 18.
    D’Amico G, Morabito A, Pagliaro L (1986) Six-week prognostic indicators in upper gastrointestinal hemorrhage in cirrhosis. In: Dianzani MU, Genntilini P (eds) Frontiers in Gastrointestinal Research: Chronic Liver Disease. Karger, Basel, pp 247–257Google Scholar
  19. 19.
    Cirera I, Bauer TM, Navasa M, Vila J, Grande L, Taurá P, Fuster J, García-Valdecasas JC, Lacy A, Suárez MJ, Rimola A, Rodés J (2001) Bacterial translocation of enteric organisms in patients with cirrhosis. J Hepatol 34:32–37PubMedCrossRefGoogle Scholar
  20. 20.
    Rasaratnam B, Kaye D, Jennings G, Dudley F, Chin-Dusting J (2003) The effect of selective intestinal decontamination on the hyperdynamic circulatory state in cirrhosis. A randomized trial. Ann Intern Med 139:186–193PubMedGoogle Scholar
  21. 21.
    Goulis J, Patch D, Burroughs AK (1999) Bacterial infection in the pathogenesis of variceal bleeding. Lancet 353:139–142PubMedCrossRefGoogle Scholar
  22. 22.
    Chin-Dusting JP, Rasaratnam B, Jennings GL, Dudley FJ (1997) Effect of fluoroquinolone on the enhanced nitric oxide-induced peripheral vasodilation seen in cirrhosis. Ann Intern Med 127:985–988PubMedGoogle Scholar
  23. 23.
    Rolando N, Gimson A, Philpott-Howard J, Sahathevan M, Casewell M, Fagan E, Westaby D, Williams R (1993) Infectious sequelae after endoscopic sclerotherapy of oesophageal varices: role of antibiotic prophylaxis. J Hepatol 18:290–294PubMedCrossRefGoogle Scholar
  24. 24.
    Selby WS, Norton ID, Pokorny CS, Benn RA (1994) Bacteremia and bacterascites after endoscopic sclerotherapy for bleeding esophageal varices and prevention by intravenous cefotaxime: a randomized trial. Gastrointest Endosc 40:680–684PubMedGoogle Scholar
  25. 25.
    Hou MC, Lin HC, Liu TT, Kuo BI, Lee FY, Chang FY, Lee SD (2004) Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial. Hepatology 39:746–753PubMedCrossRefGoogle Scholar
  26. 26.
    Jun CH, Park CH, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS, Kim SJ, Kim YD (2006) Antibiotic prophylaxis using third generation cephalosporins can reduce the risk of early rebleeding in the first acute gastroesophageal variceal hemorrhage: a prospective randomized study. J Korean Med Sci 21:883–890PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Huang-Wei Xu
    • 1
  • Jing-Houng Wang
    • 1
  • Moan-Shane Tsai
    • 2
  • Keng-Liang Wu
    • 1
  • Shue-Shian Chiou
    • 1
  • Chi-Sin Changchien
    • 1
  • Tsung Hui Hu
    • 1
  • Sheng-Nan Lu
    • 1
  • Seng-Kee Chuah
    • 1
  1. 1.Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical CenterChang Gung University College of MedicineKaohsiungTaiwan
  2. 2.Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical CenterChang Gung University College of MedicineKaohsiungTaiwan

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