@article{f78d7578c4a142829a4318f890339fde,
title = "Limited effects of antibiotic prophylaxis in patients with Child–Pugh class A/B cirrhosis and upper gastrointestinal bleeding",
abstract = "Current guidelines recommend antibiotic prophylaxis for all patients with various degrees of cirrhosis and upper gastrointestinal (UGI) bleeding. This study assessed the need for antibiotic prophylaxis in patients with low Child–Pugh scores. We retrospectively screened all patients with cirrhosis who underwent upper endoscopies for UGI bleeding in a referral hospital in Taiwan between 2003 and 2014, from which 913 patients were enrolled after excluding patients with active bacterial infections, recent antibiotic use, early death, and Child–Pugh class C cirrhosis. Among them, 73 (8%) received prophylactic antibiotics, and 45 (4.9%) exhibited 14-day bacterial infection. Neither Child–Pugh score nor model for end stage liver disease score were optimal for predicting bacterial infection because their areas under the curves were 0.610 (95% confidence interval [CI]: 0.529–0.691) and 0.666 (95% CI: 0.591–0.742), respectively. Antibiotic prophylaxis did not reduce the risks of 14-day bacterial infection (relative risk [RR]: 0.932, 95% CI: 0.300–2.891, P = 0.902), 14-day rebleeding (RR: 0.791, 95% CI: 0.287–2.181, P = 0.650), or 42-day mortality (RR: 2.710, 95% CI: 0.769–9.524, P = 0.121). The results remained similar after propensity score adjustment. On-demand antibiotic treatment might suffice for patients with Child–Pugh class A/B cirrhosis and UGI bleeding.",
keywords = "Aged, Anti-Bacterial Agents/therapeutic use, Antibiotic Prophylaxis/methods, Bacterial Infections/drug therapy, Female, Gastrointestinal Hemorrhage/drug therapy, Hospital Mortality, Humans, Liver Cirrhosis/drug therapy, Liver Function Tests, Male, Middle Aged, Retrospective Studies",
author = "Chang, {Te Sheng} and Tsai, {Ying Huang} and Lin, {Yi Heng} and Chen, {Chun Hsien} and Lu, {Chung Kuang} and Huang, {Wen Shih} and Yang, {Yao Hsu} and Chen, {Wei Ming} and Hsieh, {Yung Yu} and Wu, {Yu Chih} and Tung, {Shui Yi} and Huang, {Yen Hua}",
note = "Funding Information: This work was supported by research grants from Chang Gung Memorial Hospital, Taiwan (CORPG6F0053) to TSC, and the Ministry of Science and Technology, Taiwan (MOST 106-2314-B-182-065 to TSC; MOST108-2314-B-038-006 and MOST108-2321-B-038-003 to YHH). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: {\textcopyright} 2020 Chang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",
year = "2020",
month = jan,
day = "1",
doi = "10.1371/journal.pone.0229101",
language = "English",
volume = "15",
journal = "PLoS ONE",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "2",
}