{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T04:19:26Z","timestamp":1792210766329,"version":"4.4.0"},"reference-count":26,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,12,1]],"date-time":"2017-12-01T00:00:00Z","timestamp":1512086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,12,1]],"date-time":"2017-12-01T00:00:00Z","timestamp":1512086400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["UEG Journal"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec><jats:title>Background and aims<\/jats:title><jats:p>Current guidelines recommend antibiotic prophylaxis in all patients presenting with cirrhosis and acute variceal hemorrhage (AVH). We aimed to evaluate the characteristics and clinical impact of \u201cearly\u201d infections (developing within 14\u00a0days) of AVH in a real\u2010world setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed retrospective data from a cohort of 371 adult patients with cirrhosis and AVH all of whom had received antibiotic prophylaxis (74% men; mean age 56 years), admitted to tertiary care hospitals in Edmonton, Alberta, Canada, and Barcelona, Spain. Sensitivity analyses were presented for culture\u2010positive (confirmed) infections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean MELD was 16. Fifty\u2010two percent of patients received quinolones, 45% third\u2010generation cephalosporins and 3% other antibiotics. Fourteen percent (51\/371) developed an infection within 14\u00a0days of AVH. Seventy\u2010five percent of infections were culture positive and occurred at a mean of six days from AVH. When all infections were considered, respiratory infections were the most common (53%) followed by urinary tract infections (17%) and bacteremia (16%). Resistance patterns differed between countries. Outpatient antibiotic prophylaxis (OR 5.4) and intubation (OR 2.6) were independent predictors of bacterial infection. Bacterial infection (OR 2.6) and the MELD (OR 1.2) were independent predictors of six\u2010week mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Early bacterial infections develop in 14% of cirrhotic patients with AVH despite antibiotic prophylaxis, and have a negative impact on six\u2010week mortality. Intubation and outpatient antibiotic prophylaxis are associated with increased risk of early bacterial infections. Patients at risk should be followed closely with prompt infection workup and local antibiogram\u2010based expansion of antibiotic therapy in case of clinical decline.<\/jats:p><\/jats:sec>","DOI":"10.1177\/2050640617704564","type":"journal-article","created":{"date-parts":[[2017,4,5]],"date-time":"2017-04-05T07:12:52Z","timestamp":1491376372000},"page":"1090-1099","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":25,"title":["Bacterial infections in acute variceal hemorrhage despite antibiotics\u2014a multicenter study of predictors and clinical impact"],"prefix":"10.1002","volume":"5","author":[{"given":"Stephen","family":"Lee","sequence":"first","affiliation":[{"name":"Cirrhosis Care Clinic\u2014Gastroenterology University of Alberta Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynora","family":"Saxinger","sequence":"additional","affiliation":[{"name":"Infectious Diseases 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