S1153 Antibiotic Prophylaxis for Upper Gastrointestinal Bleed in Liver Cirrhosis; Less May Be More

Introduction: Administration of antibiotics in patients with cirrhosis and upper-gastrointestinal bleeding has been shown to improve outcomes, however, little is known regarding optimum duration of treatment. Seven days are generally recommended, but antibiotic duration has not been compared to clinical outcomes in current literature. We aimed to study the effect of shorter prophylactic antibiotic duration on patient outcomes. Methods: We conducted a retrospective cohort study of patients with cirrhosis presenting with upper-gastrointestinal bleeding at our institute from 2010 to 2018. Patients were divided into three cohorts based on duration of prophylactic antibiotics administered: 1-3 days, 4-6 days, and 7 or more days of antibiotics. Rates of infection diagnosis within 30 days, time to infection, rebleeding, and mortality were compared between the three groups with Chi-square, Fisher Exact and Kruskall-Wallace tests. Multivariable analysis was conducted to evaluate independent risk factors for infection. Results: A total of 243 patients with cirrhosis and upper-gastrointestinal bleed were included in our analysis. The three groups were well-matched in demographic and clinical variables. Twenty-seven patients developed infections within 30 days of bleed. MELD score and presence of ascites were associated with infection within 30 days. There was no significant difference in the rates of infection, time to infection, early re-bleeding, late re-bleeding, and in-hospital mortality between the three groups. Conclusion: Short course of antibiotics for prophylaxis (3 days) appears safe and adequate for prophylaxis in patients with cirrhosis with upper gastrointestinal bleeding if bleeding has abated and there is no active infection.