(593) Evaluation of Outcomes in Patients With Acute Variceal Bleed Receiving Prophylactic Antibiotics

Introduction: Patients with decompensated cirrhosis develop portal hypertension, which may cause esophageal varices that are prone to bleeding. Guidelines recommend prophylactic antibiotics as part of management of esophageal varices bleeding (EVB), yet its duration is unclear. The purpose of our study is to determine if prophylactic antibiotics decrease mortality, re-bleeding rates and mitigate infections in this population.

Methods: This retrospective case-control study analyzed patients from three Department of Health Services (DHS) facilities. ICD-9/10 codes in electronic medical records (EMR) determined eligibility. Inclusion criteria: adults ≥18 years with cirrhosis and EVB, receiving prophylactic antibiotics during hospitalization. Patients were excluded if they were transferred to non-DHS facilities, discharged from ED, had ascites requiring antibiotic(s) for spontaneous bacterial peritonitis (SBP), on antibiotics upon admission, or had EV secondary to portal vein-thrombosis. Outcomes were further stratified by antibiotic duration: 24-72 hours, >72-144 hours, or ≥144 hours. Primary outcomes include infection rates across cohorts. Data analysis involves Chi-square, ANOVA tests, and descriptive statistics.

Results: From 264 patients screened in EMR, 116 met inclusion criteria with 37 patients receiving antibiotic therapy for 24-72 hours, 67 for >72-144 hours, and 12 ≥ 144 hours. Baseline characteristics and disease severity (MELD-Na) were similar across all groups. Primary outcome (infections rate) was significantly lower with shorter duration of ABX (11%, 21%, 50% respectively, p=0.014). Bacteremia (13), pneumonia (5), and urinary tract infections (3) were common post-initial EVB resolution. Secondary outcomes: rehospitalization for re-bleeding and in-hospital mortality did not differ (p = 0.79 and p = 0.65, respectively). Exploratory outcomes: intensive care unit (ICU) and non-ICU lengths of stay differed significantly among groups (p < 0.0001). Safety outcome: no patients developed C. difficile infection.

Conclusions: A prophylactic antibiotic regimen lasting < 72 hours may be both safe and effective for patients with cirrhosis experiencing EVB, provided there is no ongoing infection; however, further research is needed. Judicious antibiotic stewardship may improve outcomes in patients with EVB.