Antibiotic prophylaxis after variceal hemorrhage reduces incidence of early rebleeding.

Background/aims: This study aims to evaluate the role of new onset infection in the initiation of early rebleeding after variceal hemorrhage in patients with liver cirrhosis and the effect of prophylactic antibiotic treatment.

Methodology: Two hundred and twenty-one consecutive admissions for variceal bleeding with no signs of infection at the time of admission were evaluated retrospectively.

Results: Systemic antibiotic prophylaxis was administered in 126 cases and significantly reduced the overall incidence of new onset infections (19.8% vs. 34.71%; p<0.01) and of early rebleeding (17.5% vs. 32.6%; p<0.01). Multivariate analysis showed strong correlation of rebleeding with new onset infection (p<0.001) and lack of prophylactic antibiotic treatment (p<0.05). Child-Pugh C cirrhosis, ventilatory assistance, and balloon tamponade were independent predictors of new onset infection (p<0.001, respectively). In the subgroup of patients with at least one predictor prophylactic treatment nearly halved the incidence of infections and rebleedings while in patients without predictors it had no significant effect.

Conclusions: For the first time our data indicate a role for new onset infections in initiating early rebleedings. Immediate prophylactic antibiotic treatment for patients at high risk of infection might be effective in lowering both, the risk of acquiring infections and early rebleeding.