Antibiotic use in cirrhotic children with acute upper gastrointestinal bleeding

Abstract

Prior studies have demonstrated positive impacts of antibiotic use on reducing mortality, rebleeding events, and length of hospitalization in adult cirrhotic patients with acute upper gastrointestinal bleeding (UGIB). We aimed to investigate the use of antibiotics in cirrhotic children with acute UGIB and its impact on patient outcomes. This was a retrospective study using the Pediatric Health Information System database. Cirrhotic patients aged 0 to 18 years with acute UGIB, admitted between October 2005 and September 2015, were identified based on ICD-9 codes. Patients with no documented endoscopy during admission were excluded. Forty-four (23 females) cirrhotic children were eligible for data analysis. The median patient age was 6 years. Etiology of acute UGIB included esophageal varices (n = 37), non-variceal bleeding (n = 4), and both (n = 3). A significant proportion of cirrhotic children with acute UGIB (n = 30, 68%) were given intravenous antibiotics within 48 hours of admission. Among children who did not develop bacteremia, 68% received antibiotics vs. 32% who did not ( P = .6). The rate of readmission within 30 days of discharge was 7% in patients with antibiotics vs. 21% in those without antibiotics ( P = .3). This study suggested that antibiotic use within 48 hours of admission in cirrhotic children with acute UGIB might have a positive impact on the percentage of children free of bacteremia and the readmission rate. A prospective study should investigate whether prophylactic antibiotics should be targeted only to a subgroup of cirrhotic children with acute UGIB who are particularly at high risk for bacterial infection.

Association Between Perioperative Costs and Induction Immunosuppression in Pediatric Liver Transplant Recipients

“…The PHIS database supports a wide range of improvement activities including clinical effectiveness, resource utilization, and care guideline development. Data from PHIS has been widely used to identify trends in health care management (6,7), suggest areas for improved clinical care (8), investigate financial outcomes (9), and advance research. PHIS includes patient demographics, procedures, diagnoses by International Classification of Diseases, Ninth Revision (ICD‐9) and International Classification of Diseases, Tenth Revision (ICD‐10) codes, and billed transactions (4,5).…”

Pediatric Endoscopy, Update 2020

“…Octreotide: 1 mg/kg as flush injection (max. 50 mg), followed by 1 mg/kg/h Somatostatin increase of dosage every 8 h possible to 4 mg/kg (max 250 mg within 8 h) After successful stopping of the bleed, doses reduction of 50% in 8 h A study suggested that antibiotic use within 48 h of admission in cirrhotic children with acute UGIB might have a positive impact on the percentage of children free of bacteremia and the readmission rate [70].…”

Antibiotic prophylaxis in cirrhosis patients with upper gastrointestinal bleeding: An updated systematic review and meta‐analysis

“…Meanwhile, controversies remained over the survival benefit of antibiotic prophylaxis in CTP‐A patients with UGIB. While the earlier randomized study showed that prophylactic antibiotic might improve survival, 10 these benefits were not consistently demonstrated in the recent studies 11–14 …”

“…While the earlier randomized study showed that prophylactic antibiotic might improve survival, 10 these benefits were not consistently demonstrated in the recent studies. [11][12][13][14] With conflicting data from recent studies, it is, therefore, timely and clinically relevant to systematically review the existing literature and evaluate the exact benefit of antibiotic prophylaxis in cirrhosis patients with UGIB. Prior meta-analysis was performed more than a decade ago and did not address several key outcomes of variceal bleeding such as 6-week mortality, need for salvage therapy following initial endoscopic hemostasis as well as blood transfusion requirement.…”