EVALUATING COMPLIANCE TO THE USE OF PROPHYLACTIC ANTIBIOTICS IN CIRRHOTIC PATIENTS PRESENTING W...

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EVALUATING COMPLIANCE TO THE USE OF PROPHYLACTIC ANTIBIOTICS IN CIRRHOTIC PATIENTS PRESENTING WITH UPPER GASTROINTESTINAL HEMORRHAGE AT THE HAMILTON HEALTH SCIENCES CENTER

K Baath, J Marshall

McMaster University, Hamilton, Ontario
Aims: To determine the rate of prophylactic antibiotic administration in cirrhotic patients presenting with upper gastrointestinal bleeding (UGIB). Also, to elucidate clinical characteristics of treated and untreated patients.
Methods: A comprehensive chart review of all cases of UGIB in cirrhotic patients presenting to Hamilton Health Sciences Center between April 2005 and March 2008 was conducted. Data on various parameters was recorded; this included clinical and laboratory features supporting the diagnosis of cirrhosis, symptoms of UGIB, Child-Pugh scores, endoscopic findings and interventions, and outcome measures including length of hospitalization and mortality rate.
Results: A total of 59 UGIB presentations in 45 patients were identified. Prophylactic antibiotics were started in 68% of the cases. Treated patients compared to untreated patients had a higher frequency of ascites (58% vs. 37%), thrombocytopenia or splenomegaly (50% vs. 8%) and were also more likely to have Child-Pugh class B or C cirrhosis. Hemetemesis was a more common symptom in the treated group (60% vs. 37%) and melena was more common in the untreated group (74% vs. 48%). Treated patients were also much more likely to be admitted to the intensive care unit (40%) than untreated patients (16%). Most common endoscopic finding was esophageal varices in both groups, however, no cause for bleeding could be identified in 21% of treated patients and 32% of the untreated patients. Interestingly, 4 out of the 40 treated patients died during their hospitalization and there was no mortality in the untreated patients. All patients that died had been admitted to the ICU within the first 24 hours of their admission.
Conclusions: Above results indicate that the rate of prophylactic antibiotic administration in cirrhotic patients presenting with UGIB needs to be improved. However, data also suggests that patients with clinical and laboratory evidence of portal hypertension are more likely to be treated with prophylactic antibiotics than patients with less advanced cirrhosis.

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