The Clinical Study Of Antibiotics Prophylaxis In Liver Cirrhotic Patients With Upper Gastrointestinal Bleeding

Object:This study is designed to survey clinical features in cirrhosis with upper gastrointestinal bleeding, and analyze the infection type and location, the infection time, the factor of influence of infection and death date, to investigate the effect on the infection of antimicrobial prophylaxis for patients with upper gastrointestinal bleeding due to liver cirrhosis. Methods: Since February 2010, according to AASLD guide, we give ceftriaxone 1g/d to patients with upper gastrointestinal bleeding due to liver cirrhosis for preventing infections. All clinical documented patients with upper gastrointestinal bleeding due to liver cirrhosis were focused and chosen from 2005 to 2014 in Tianjin Second People Hospital. According to the rule out standard, collect the clinical background, features, infections and outcomes.We chose systematically 175 patients of upper gastrointestinal bleeding on liver cirrhosis from the admission before February in 2010 as the non-antibiotics group.272 of the admission patients after the date are all included in the study as the antibiotics prophylaxis group. The incidence rate of the infections, the infection type and location, the infection time, rebleeding, hospitalization costs and length within 10 days was compared between two groups. Results:1. 447 cases patients in cirrhosis with upper gastrointestinal bleeding from 1136 cases are included in the study. There were 30 patients with infections in the antibiotics prophylaxis group and 66 patients with infections in the non-antibiotics group.The incidence rate of the infections of the antibiotics prophylaxis group which was 11.02%,were significantly lower than the incidence rate of the infections of the non-antibiotics group which was 37.71%.And we can observe that there was significant difference between the two groups with respect to the infections(P<0.05).2.The incidence rates of the patients in the antibiotics prophylaxis group with spontaneous bacterial peritonitis, urinary infection, bacteremia,respiratory infection, possible infections were significantly less than the ones in the non-antibiotics group(10.29%vs0.74%、2.28%vs0.00%、2.29%vs0.37,13.71%vs6.61%、8.57%vs3.31%). No-prophylactic use were confirmed as the independent risk factors through the multivariate logistic analysis.3. Patients on liver cirrhosis with upper gastrointestinal bleeding hemorrhage were detected 26 strains of bacteria in 96 specimens. The microorganisms mainly include: Escherichia.coli 11 strains, Klebsiella pneumonia 5 strains, Methicillin-resistant Staphylococcus aureus 3 strains, Enterococcus faecium 2 strains, P.Aeruginosa 1 strains, Acinetobacter baumanii 1 strains.4. 17 cases in the antibiotics prophylaxis group(14.29%)and 25 cases in the non-antibiotics group(6.25%) were died. there was significant difference between the two groups. 10-day survival rate were found a significant deference between the two groups(P <0.05). 10-day survival rate were found a significant deference between infected group and non-infected group(P <0.05). 10-day survival rate were found a significant deference between the rebleeding group and the non-rebleeding group.5. 23 cases were rebleeding in the antibiotics prophylaxis group. 36 cases were rebleeding in the non-antibiotics group. The incidence rate of rebleeding in the non-antibiotics group was 20.57%, and the incidence rate of rebleeding in the non-antibiotics group was 8.46%. Infection was confirmed as the independent risk factors through the multivariate logistic analysis.6. In the antibiotics prophylaxis group, the time of infection was(6.2±2.2) d. In the non-antibiotics prophylaxis group, the time of infection was(4.6±2.2)d. There was significant difference between the two groups with respect to the infections(P<0.05).7. Before the time of intervention, the incidence rate of the infections, re-bleeding and death is 15.64%,10.43% and 7.36%.Conclusion:1. non antibiotics prophylaxis was the high risk factors of the infection of cirrhosis with upper gastrointestinal bleeding. The use of antimicrobial prophylaxis for patients with upper gastrointestinal bleeding due to liver cirrhosis can obviously decrease the rate of infection. Infection,not re-bleeding, affects the survival period of patients2. After the intervention, compliance rate of prophylaxis increased.