Infections in Acute Variceal Bleeding and Role of Antibiotics

Due to several defective in bacterial defense mechanisms, cirrhotic patients are susceptible to bacterial infections. The most common infections are spontaneous bacterial peritonitis (23-32%), urinary tract infection (10-41%), pneumonia (17-21%) and bacteremia (13-21%). Majority of infections involved in a single site (3) , gram negative bacteria especially Escherichia coli being the most common pathogen detected. Apart from impairment of the reticuloendothelial system, small bowel dysmotility, bacterial overgrowth in the small intestine, and increased intestinal permeability in cirrhotsis, variceal bleeding has been reported as an independent factor for bacterial infection. Husová, et al reported a higher rate of bacterial infection among patients with acute portal hypertensive related bleeding (25 of 35 patients, 71%) than among patients with liver cirrhosis and portal hypertension without acute bleeding (14 of 35 patients, 40%, p <0.01). Various tubes insertion (NG, CVP, endotracheal and Senstagen-Blakemore) causing infections has been concerned as another important factor. Gastric content refluxation as an endogenous source for bacterial colonization of ventilator tubing systems was demonstrated from a surveillance study in patients who admitted in the intensive care unit. One of the well known infections related to Senstaken-Blakemore tube insertion is the development of aspiration pneumonia after prolonged tube insertion. To date, there has been no direct study comparing the risk from these tubes causing infection in variceal bleeders. Prophylactic antibiotics and risk of infection, mortality and rebleeding