1582. Is Antibiotic Prophylaxis Needed for All Acute Variceal Bleeds in Decompensated Cirrhosis? A Retrospective Pilot Study. (26th November 2018)

• Record Type: Journal Article
• Authors: Thyssen, Emil; Hensel, Drew; Nolan, Nathanial; Whitt, Stevan; Regunath, Hariharan
• Is Part Of: Open forum infectious diseases. Volume 5(2018)Supplement 1
• Page Start: S494
• Page End: S495
• Publication Date: 2018-11-26
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy210.1410
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Guidelines recommend empiric antibiotic prophylaxis for acute variceal bleeding, but no studies compare the outcomes between those treated with guideline recommended duration and those not treated (low suspicion) or treatment duration truncated (negative work up). We hypothesized that outcomes may not be different between the two groups. Methods: Retrospective pilot study for the period 2013–2017. Cases were extracted using ICD 9(4, 560) and ICD 10(I8501, I8511) codes and the following criteria were applied. Inclusion: Age >18 years and decompensated cirrhosis with acute variceal bleeding. Exclusion: Age < 18 years, septic shock, receipt of antibiotics < 14 days before admission, human immunodeficiency virus infection. Data gathered on demographics, APACHE II, Charlson score, modified Child-Turcotte-Pugh classification (CTP), mortality at 6 weeks, re-bleeding within 7 days, readmissions (30 and 90 days), incidence of infections at admission and follow-up. Using SPSS, we compared those who received antibiotics < 3 days to ≥ 3 days. Results: Eighty-three cases met criteria (M:F = 52:31, age = 54.5 ± 11.6 years), CTP: A = 20(24.1%), B = 34 (41.9%), C = 29(33.7%). Alcohol was etiology in 57(68.67%) [52(91.2%) alcohol only, 5(8.8%) with alcohol and viral hepatitis]; hepatitis C virus (HCV): 12/83 (14.6%)[6(50%) HCV only]; hepatitis B virus: 3(3.6%); NASH: 12(14.6%) [9(75%) NASH only, 2(16.7%) with HCV, 1 with autoimmune hepatitis)]; cryptogenic: 3(3.6%); autoimmune: 2(2.4%), others: 4(ischemic, metastases, biliary cirrhosis, transplant). Antibiotics were either not administered or truncated in 21(25.3%) patients. In comparing guideline concordant (≥3 days) and truncated (<3 days) groups, no statistically significant difference was present for APACHEII, Charlson score, mortality (10 vs. 3, P 0.928), re-bleeding (2 vs. 0, P 0.387) and readmission at 30 and 90 days (18 vs. 3, P 0.147; 11 vs. 3, P 0.715). Drug-resistant infections were seen in 4(4.8%) patients requiring readmissions within 90 days. Conclusion: We found no differences in outcomes between guideline concordant and truncated duration of antimicrobial prophylaxis for acute variceal bleeding. Truncating the duration of empiric prophylactic antibiotics reduces unnecessary antibiotic use. Disclosures: All authors: No reported disclosures.