Despite these benefits, since antibiotics are associated with risks such as Clostridium difficile and multidrug resistance, it may be possible and preferable to avoid prophylaxis in patients at low risk of infection. As liver disease severity is a key predictor of infection and of poor clinical outcomes in cirrhosis, we hypothesized that a subgroup of Child Pugh A (CPA) cirrhotic patients with AVH who had Tamoxifen datasheet not received antibiotic prophylaxis would nevertheless have a low risk of bacterial infection and good clinical outcomes. Methods Patients were selected from a retrospective database of adult
patients with cirrhosis and AVH (1996 to 2009) collected from two tertiary care hospitals. The diagnosis of cirrhosis was based on liver biopsy or on compatible clinical and imaging findings. For the purposes of this study, we considered only those patients who had: i) sufficient information to evaluate Child Pugh class, ii) did not have a bacterial infection diagnosed on the day of AVH and iii) were not given antibiotics on the day of AVH (ie) not already on antibiotics or given antibiotic prophylaxis. This lack of use of antibiotic therapy was at the discretion of the treating physician. Variables are presented using
means and standard deviations or Metformin price proportions. Results 〇f the 610 cases in our database, 252 patients met all criteria for inclusion. Two-thirds of these cases occurred between 1996 and 2002. 〇f the included patients, 64% were male, Carnitine dehydrogenase 48% had alcohol related liver disease and the mean age was 56 ± 13 with a baseline MELD score of 15 ± 7. Sixty-seven percent received intravenous octreotide and 92% received endoscopic therapy. Between days 2 and 10 after the bleed, bacterial infection developed in 20% (51/252) of patients. In these 51 infected patients, the most common causes of infection were pneumonia (31%),
spontaneous bacteremia (29%) and spontaneous bacterial peritonitis (24%). Infection rates increased with Child Pugh class: 5% (2/42) in CPA, 16% (19/122) in CPB and 34% (30/88) in CpC. The 42 CPA patients did well with 100% hemostasis, a 6week re-bleeding rate of 7% and a 6-week mortality rate of 2.4% (a hepatocellular carcinoma related death). Conclusions Child Pugh A patients presenting with AVH have low rates of bacterial infection and excellent clinical outcomes in the absence of antibiotic prophylaxis. Antibiotic prophylaxis can potentially be avoided in this group of patients. Disclosures: The following people have nothing to disclose: Puneeta Tandon, Adam Keough, Ravin J. Bastiampillai, Saumya Jayakumar, Michelle Carbonneau, Eric K. Wong, Dina Kao, Mang M. Ma Background & Aims: Esophageal varices (EVs) are complications of liver cirrhosis; screening and periodic surveillance for EVs by esophagogastroduodenoscopy (EGD) are recommended for these patients.