Background: Bacterial infections are common in cirrhotic patients with acute gastrointestinal portal hypertensive bleeding, occurring in 20% within 48 hours. Outcomes including early re-bleeding and failure to control bleeding are strongly associated with bacterial infection. The use of short-term prophylactic antibiotics in patients with cirrhosis and GI hemorrhage with or without ascites has been shown not only to decrease the rate of bacterial infections but also to increase survival. This improved survival is partly related to a decrease in the incidence of early re-bleeding in patients with GI hemorrhage who receive prophylactic antibiotics. Therefore, short-term antibiotic prophylaxis should be considered standard practice in all patients with cirrhosis and acute variceal hemorrhage. The antibiotic of choice in most centers is intravenous Ceftriaxone at a dose of 1 g daily. Duration of antibiotic prophylaxis is short term, for 5-7 days (to be discontinued when hemorrhage resolve and vasoactive drugs discontinued).
300 charts were reviewed in retrospective data analysis for patients presented during 2017 and 2018 with cirrhosis related diagnoses and gastrointestinal bleeding related diagnoses. 43% (171 patients) of the presented patients had active cirrhosis.
Anatomy and EGJ opening determine outcome in achalasia. Of those 171 patients:
- 17% (30 of 171) patients that have cirrhosis presented in 2017 and 2018 with gastrointestinal bleeding,
- 36% (11 out of the 30) patients received empiric antibiotics, whether as prophylaxis or for other indications such as sepsis,
- 64% (19 out of the 30) patients, antibiotics were not started on admission; therapy started on the second or third day by gastroenterology service, or other service/team.
Our results showed that the majority of patients (64%) with cirrhosis presenting with GI bleed were not started on a proper prophylaxis antibiotic. The ideas and the actions that were proposed and implemented post this study: Increase awareness through nursing and pharmacy staff teaching sessions, as well as residents didactic lectures. Also, through periodic awareness/teaching emails to medical staff. Hospital protocols were reviewed. A questionnaire step, “Warning window,” were integrated into the EMR, that to pop up when a medical provider add “liver cirrhosis” or “variceal hemorrhage” to patient admitting/visit diagnosis list. This intervention was implemented recently. In the next phase, we plan to gather data obtained post intervention, and to be studied and compared.