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Real-world efficacy of antibiotic prophylaxis for upper gastrointestinal bleeding in cirrhotic patients in Japan

  • Original Article―Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 19 December 2023

Abstract

Background and Aims

Antibiotic prophylaxis is recommended for cirrhotic patients with upper gastrointestinal bleeding (UGIB). However, the frequency of bacterial infection in such patients has remarkably decreased over the decades, which has reduced the necessity for prophylaxis. Therefore, here we investigated the real-world adherence and effectiveness of antibiotic prophylaxis in cirrhotic patients with UGIB in Japan.

Methods

This population-based study was conducted with a Japanese real-world database of the Health, Clinic, and Education Information Evaluation Institute. We enrolled cirrhotic patients who were hospitalized for UGIB between April 2010 and March 2020. After those who died within 24 h and who had aspiration pneumonia at admission were excluded, 1232 patients were analyzed. Rates of 6-week mortality, in-hospital bacterial infection, 30-day readmission, and length of hospital stay were evaluated.

Results

Prophylactic antibiotics were prescribed in 142 (11.5%) patients. Multivariate analysis revealed that antibiotic prophylaxis was not significantly associated with either 6-week mortality or bacterial infection. After propensity score matching, the rates of 6-week mortality (7.2% vs. 8.4%, P = 0.810), bacterial infection (9.6% vs. 4.2%, P = 0.082), and 30-day unexpected readmission (7.2% vs. 7.8%, P = 1.000) were similar in patients with and without prophylaxis, whereas the median length of hospital stay was significantly longer in patients with prophylaxis (17 days vs. 13 days, P = 0.013).

Conclusions

Under current real-world circumstances in Japan, prophylactic antibiotics were prescribed in only 11.5% of cirrhotic patients with UGIB and were not associated with better clinical outcomes.

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Acknowledgements

The authors thank William R Brown, M.D., director of the International Medical Editing Service, LLC, USA, for the English language review. This work was supported by grants from the Japan Agency for Medical Research and Development (AMED) (20IA1012).

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki, Okayama, 710-8602, Japan

    Masayuki Ueno, Toshifumi Mano, Takahisa Kayahara, Hiroyuki Takabatake, Youichi Morimoto, Kazuhiro Matsueda & Motowo Mizuno

  2. Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Masayuki Ueno

  3. Department of Public Health Research, Kurashiki Clinical Research Institute, Okayama, Japan

    Takashi Fujiwara & Hironobu Tokumasu

  4. Department of Otolaryngology/Head and Neck Surgery, Kurashiki Central Hospital, Okayama, Japan

    Takashi Fujiwara

  5. Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan

    Toshio Fukuoka

Authors
  1. Masayuki Ueno
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  2. Takashi Fujiwara
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  3. Hironobu Tokumasu
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Contributions

(I) Conception and design: M.U., T.F., H.T., T.K., H.T., Y.M., K.M., and T.F. (II) Data curation: M.U., T.F., H.T., and T.M. (III) Formal analysis: M.U., T.F., H.T., and T.F. (IV) Funding acquisition: T.F. (V) Supervision: M.M., (VI) Manuscript writing: All authors. (VII) Final approval of manuscript: All authors.

Corresponding author

Correspondence to Masayuki Ueno.

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The authors declare that there is no conflict to disclose.

Ethics

All procedures were performed in accordance with the Helsinki Declaration of 1964, as revised in 2013. The Medical Ethics Committee of Kurashiki Central Hospital approved the study protocol (No. 3611). The Committee waived the informed consent requirement because only anonymous data were analyzed.

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Ueno, M., Fujiwara, T., Tokumasu, H. et al. Real-world efficacy of antibiotic prophylaxis for upper gastrointestinal bleeding in cirrhotic patients in Japan. J Gastroenterol 58, 766–777 (2023). https://doi.org/10.1007/s00535-023-02000-y

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  • DOI: https://doi.org/10.1007/s00535-023-02000-y

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