Clinical–liver, pancreas, and biliary tractNorfloxacin vs Ceftriaxone in the Prophylaxis of Infections in Patients With Advanced Cirrhosis and Hemorrhage
Section snippets
Patients
The study was performed in patients with cirrhosis admitted to 4 Spanish hospitals for the treatment of an upper gastrointestinal hemorrhage between February 2000 and April 2004. Diagnosis of cirrhosis was based on clinical, laboratory, and ultrasonographic data or on histology. Inclusion criteria were as follows: age 18–80 years, hematemesis and/or melena within 24 hours prior to inclusion, and advanced cirrhosis as defined by the presence of 2 or more of the following signs of liver failure:
Results
A total of 1369 cirrhotic patients with gastrointestinal hemorrhage were screened. Of these, 1245 patients were not included because of absence of 2 signs of advanced liver failure (884 patients), presence of infection at admission (253 patients), presence of advanced hepatocellular carcinoma or other neoplasia (106 patients), antibiotic treatment other than oral norfloxacin at admission (54 patients), age over 80 years (21 patients), HIV infection (19 patients), and other causes including
Discussion
The results of the current study confirm that patients with cirrhosis, gastrointestinal hemorrhage, and advanced liver failure are at great risk of developing bacterial infections. Despite the prophylactic administration of antibiotics, 25 of the 111 patients (23%) included in the study developed bacterial infections within 10 days after inclusion. In 8 patients, the infection was severe (spontaneous bacteremia or spontaneous bacterial peritonitis).
An important finding of the current study is
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Supported in part by grants from the Fondo de Investigación Sanitaria (FIS 00/0921) and the Instituto de Salud Carlos III (BEFI 00/9380 and C03/02).