Frequency of infections in cirrhotic patients presenting with acute gastrointestinal haemorrhage

Abstract

The frequency of infection at the time of admission with upper gastrointestinal haemorrhage has been determined in 149 successive cirrhotic patients admitted to an intensive care unit. Infection status was investigated by clinical examination, chest X-ray, and blood, urine and ascitic fluid culture. At initial examination infection was present in 32 patients (22 per cent) and was often in the form of septicaemia or spontaneous peritonitis; the bacteria responsible were frequently digestive in origin. At endoscopy, acute lesions of gastroduodenal mucosa were more frequent among infected patients, whereas gastro-oesophageal varices and chronic gastroduodenal ulcers were more frequent among the non-infected patients. Acute mucosal lesions were observed in 70 per cent of infected patients and in 19 per cent of non-infected patients. The mortality rate was higher in infected patients. Infection and the frequency of acute mucosal lesions were related to the severity of the cirrhosis. It is suggested that these lesions could be due to stress secondary to infection.

Improved survival after variceal bleeding in patients with cirrhosis over the past two decades

“…Another cause of morbidity and mortality is bacterial infection, which is common after variceal bleeding in patients with cirrhosis. 22 In addition, infection has been associated with failure to control bleeding. 23 The use of prophylactic antibiotics decreased the rate of bacterial infections in randomized controlled trials, and a meta-analysis showed that it was associated with improved survival.…”

Management of gastro-oesophageal varices

“…Spontaneous bacterial peritonitis is the commonest manifestation of infection which is usually caused by enteric Gram-negative bacteria (mainly Escherichia coli), although Grampositive organisms are also found in cases where the predominant site of infection is the lower respiratory tract. Mortality has been shown to be higher in these patients than in non-infected patients 7,8 . It has also been shown that infections also predispose to recurrent variceal haemorrhage 9 .…”

Spontaneous bacterial peritonitis

“…Bacterial infection is a common issue in cirrhotic patients with acute GI bleeding -up to 20% are infected at admission and around 50% become infected during their hospital stay (85)(86)(87)(88)(89)(90)(91)(92)(93)(94). In addition, infection risk has been shown to be higher in patients with advanced cirrhosis and severe GI bleeding (91,92,95).…”

“…A meta-analysis of 5 studies of antibiotic prophylaxis in these patients concludes that antibiotics are effective for the prevention of bacterial infection, which is associated with significantly improved survival (by 9.1% in the treated group) (92). According to a prospective, randomized study, norfloxacin 400 mg/12 hours PO or via a nasogastric tube for 7 days prevents bacterial infection, specifically SBP, in cirrhotic patients with gastrointestinal bleeding (87). Intravenous ofloxacin may be used during active bleeding (88).…”