Analysis of prophylactic antibiotic therapy for patients with cirrhosis and acute gastrointestinal bleeding

• Grant number: 23/14281-3
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Effective date (Start): February 01, 2024
• Effective date (End): January 31, 2025
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Fernando Gomes Romeiro
• Grantee: Clara Fantinelli Moreno
• Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil

Abstract

Cirrhosis is a serious disease that usually remains asymptomatic until decompensating events, which occurs after development of portal hypertension. Among these events, one of the most serious is upper gastrointestinal bleeding (UGIB), an emergency that causes hematemesis, melena and/or hematochezia. UGIB incidence is up to 25%-40% among these patients, with mortality reaching up to 30% of the ones with advanced cirrhosis (Child-Pugh C). For the management of these cases, the European Consensus proposes an initial assessment with hemodynamic stabilization, fluid resuscitation, vasoconstrictor therapy (somatostatin analogues or terlipressin) and prophylactic antibiotics (ceftriaxone or norfloxacin), which mainly acts against Gram-negative bacilli. After the endoscopy, these drugs must be maintained for 3 to 5 days. Antibiotic therapy seeks to prevent infections that increase the risk of rebleeding, as bacterial infection is a risk factor for recurrent bleeding and increases mortality. Diabetic patients with cirrhosis have shorter survival and a higher risk of complications, because diabetes contributes to accelerating the progression of liver fibrosis and is a predisposing factor for infections. To date, there is no specific score for UGIB that can be used to measure the severity of this cirrhosis decompensation. The present study is part of the CAGIB score validation study, which evaluates whether this score is better than cirrhosis severity scores for predicting mortality in UGIB patients with cirrhosis. In this sub-analysis of patients included in Brazil, the objective will be to evaluate whether patients with cirrhosis hospitalized for UGIB received prophylactic antibiotic therapy, which antimicrobial was used, whether there was any infection after UGIB, and whether the presence of diabetes would be a risk factor for the development of infections in this population. To this end, an observational, retrospective and prospective study will be carried out by collecting data from the electronic medical records of patients with cirrhosis hospitalized for gastrointestinal bleeding.