The outcome of prophylactic intravenous cefazolin and ceftriaxone in cirrhotic patients at different clinical stages of disease after endoscopic interventions for acute variceal hemorrhage

Abstract

Antibiotic prophylaxis with norfloxacin, intravenous ciprofloxacin, or ceftriaxone has been recommended for cirrhotic patients with gastrointestinal hemorrhage but little is known about intravenous cefazolin. This study aimed to compare the outcome of intravenous cefazolin and ceftriaxone as prophylactic antibiotics among cirrhotic patients at different clinical stages, and to identify the associated risk factors. The medical records of 713 patients with acute variceal bleeding who had received endoscopic procedures from were reviewed. Three hundred and eleven patients were entered for age-matched adjustment after strict exclusion criteria. After the adjustment, a total of 102 patients were enrolled and sorted into 2 groups according to the severity of cirrhosis: group A (Child's A patients, n = 51) and group B (Child's B and C patients, n = 51). The outcomes were prevention of infection, time of rebleeding, and death. Our subgroup analysis results failed to show a significant difference in infection prevention between patients who received prophylactic cefazolin and those who received ceftriaxone among Child's A patients (93.1% vs. 90.9%, p = 0.641); however, a trend of significance in favor of ceftriaxone prophylaxis (77.8% vs. 87.5%, p = 0.072) was seen among Child's B and C patients. More rebleeding cases were observed in patients who received cefazolin than in those who received ceftriaxone among Child's B and C patients (66.7% vs. 25.0%, p = 0.011) but not in Child's A patients (32% vs. 40.9%, p = 0.376). The risk factors associated with rebleeding were history of bleeding and use of prophylactic cefazolin among Child's B and C patients. In conclusion, this study suggests that prophylactic intravenous cefazolin may not be inferior to ceftriaxone in preventing infections and reducing rebleeding among Child's A cirrhotic patients after endoscopic interventions for acute variceal bleeding. Prophylactic intravenous ceftriaxone yields better outcome among Child's B and C patients.

Figure 1. Actuarial probability of remaining free of infection in cirrhotic patients at all stages.

No statistically significant difference was observed between the cefazolin and ceftriaxone groups (p = 0.319).

Figure 2. Actuarial probability of remaining free of infection at different clinical stages of cirrhotic patients.

There was a similar probability of remaining free of infection between patients who were prescribed with intravenous cefazolin and those prescribed with ceftriaxone in Child’s A group (p = 0.641 by log-rank test) (A). A trend of significance was observed in favor of patients prescribed with prophylactic ceftriaxone in Child’s B and C group (p = 0.072) (B).

Figure 3. Actuarial probability of remaining free of rebleeding in cirrhotic patients at all stages.

No statistically significant difference was observed between the cefazolin and ceftriaxone groups (p = 0.220).

Figure 4. Actuarial probability of remaining free of rebleeding at different clinical stages of cirrhotic patients.

There was a similar probability of remaining free of rebleeding between patients who were prescribed with intravenous ceftriaxone and those prescribed with cefazolin in Child’s A group (p = 0.376 by log-rank test) (A). A significantly higher probability of remaining free of rebleeding was observed in those who were prescribed with intravenous cefazolin than in those given ceftriaxone in Child’s B and C group (p = 0.011) (B).