Evidence map›Paper›PMID 29238587›Full record

ArticleUnited European gastroenterology journal2017

Bacterial infections in acute variceal hemorrhage despite antibiotics-a multicenter study of predictors and clinical impact.

Stephen Lee, Lynora Saxinger, Mang Ma, Verónica Prado, Joaquin Fernández, Deepali Kumar, Juan Gonzalez-Abraldes, Adam Keough, Ravin Bastiampillai, Michelle Carbonneau and 2 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in United European gastroenterology journal, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
0.6field-weighted citation impact, top 34% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.

  1. Guideline
  2. Trial
  3. Article
  4. Article
  5. Article
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  7. Diagnosis and Management of Esophagogastric Varices.Diagnostics (Basel, Switzerland) · 2023
    Review
  8. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 3 institutions in 2 countries.

Stephen LeeCirrhosis Care Clinic-Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
Lynora SaxingerInfectious Diseases, University of Alberta, Edmonton, Alberta, Canada.
Mang MaCirrhosis Care Clinic-Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
Verónica PradoLiver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.
Joaquin FernándezLiver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.
Deepali KumarInfectious Diseases University of Toronto, Toronto, Ontario, Canada.
Juan Gonzalez-AbraldesCirrhosis Care Clinic-Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
Adam KeoughCirrhosis Care Clinic-Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
Ravin BastiampillaiCirrhosis Care Clinic-Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
Michelle CarbonneauCirrhosis Care Clinic-Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
Javier FernandezInfectious Diseases University of Toronto, Toronto, Ontario, Canada.
Puneeta TandonCirrhosis Care Clinic-Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
University of Alberta · CAUniversity of Toronto · CAConsorci Institut D'Investigacions Biomediques August Pi I Sunyer · ES

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimsCurrent guidelines recommend antibiotic prophylaxis in all patients presenting with cirrhosis and acute variceal hemorrhage (AVH). We aimed to evaluate the characteristics and clinical impact of "early" infections (developing within 14 days) of AVH in a real-world setting.

methodsWe analyzed retrospective data from a cohort of 371 adult patients with cirrhosis and AVH all of whom had received antibiotic prophylaxis (74% men; mean age 56 years), admitted to tertiary care hospitals in Edmonton, Alberta, Canada, and Barcelona, Spain. Sensitivity analyses were presented for culture-positive (confirmed) infections.

resultsThe mean MELD was 16. Fifty-two percent of patients received quinolones, 45% third-generation cephalosporins and 3% other antibiotics. Fourteen percent (51/371) developed an infection within 14 days of AVH. Seventy-five percent of infections were culture positive and occurred at a mean of six days from AVH. When all infections were considered, respiratory infections were the most common (53%) followed by urinary tract infections (17%) and bacteremia (16%). Resistance patterns differed between countries. Outpatient antibiotic prophylaxis (OR 5.4) and intubation (OR 2.6) were independent predictors of bacterial infection. Bacterial infection (OR 2.6) and the MELD (OR 1.2) were independent predictors of six-week mortality.

conclusionsEarly bacterial infections develop in 14% of cirrhotic patients with AVH despite antibiotic prophylaxis, and have a negative impact on six-week mortality. Intubation and outpatient antibiotic prophylaxis are associated with increased risk of early bacterial infections. Patients at risk should be followed closely with prompt infection workup and local antibiogram-based expansion of antibiotic therapy in case of clinical decline.

Indexed as

antibiotic prophylaxisantibiotic resistanceCirrhosismicrobiologyvariceal bleed

Identifiers

PMID29238587
PMCPMC5721982
OpenAlexW2604475398

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.