Bacterial infection and its relation to the genesis and course of varicose hemorrhage

Czech version

Authors: L. Husová ¹; J. Juránková ²; J. Lata ¹; M. Šenkyřík ¹; V. Příbramská ¹; M. Dastych Jr ¹; R. Kroupa ¹; D. Králová ³
Authors‘ workplace: Interní gastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Petr Dítě, DrSc. ¹; Oddělení klinické mikrobiologie FN Brno, pracoviště Bohunice, přednostka prim. MUDr. Alena Ševčíková ²; Institut biostatistiky a analýz Lékařské fakulty MU Brno, přednosta doc. RNDr. Ladislav Dušek, Ph. D. ³
Published in: Vnitř Lék 2007; 53(12): 1255-1264
Category: Original Contributions

Overview

Acute hemorrhage from esophageal varices due to portal hypertension is a frequent and serious complication of liver cirrhosis. Bacterial infection may be one of the factors influencing such hemorrhage. Endotoxins may increase portal tension and at the same time result in primary hemostasis disorder, thus becoming one of the causes of hemorrhage. The authors of the paper compared the incidence of bacterial infection in 53 patients with varicose hemorrhage due to portal hypertension with 62 patients with liver cirrhosis and portal hypertension without varicose hemorrhage. At least one pathogen was found in considerable 61.1 % of the total of patients in the liver cirrhosis group, while the difference between the two groups was but insignificant. No statistically significant difference was found between the group of patients with hemorrhage and those without hemorrhage in terms of presence of bacterial infection in hemoculture, urine, throat, faeces and ascites, nor was there a difference in the etiology of the G+ bacteria, G– bacteria or fungi and yeast infectious agents in the hemoculture, urine, throat, faeces and ascites in either of the groups. No statistically significant difference was found in comparing the patients with a recurrence of hemorrhage (or with mortality) and with infection with those without recurrence of hemorrhage. Bacterial infection was more often found in patients with a recurrence of hemorrhage (75 %) as compared with those without any recurrence (52 %), and also in patients who died bacterial infection was proven more often than in those who survived (61.9 % vs. 58.1 %, respectively). There was no difference in morbidity or recurrence of hemorrhage between the patients treated with norfloxacin and ampicilin/sulbactam. No statistically significant difference was recorded between the 1st and 5th day in terms of decrease in bacterial infection. A significant difference was found in the urine etiological agent, where a significant increase in the share of fungal and yeast urine infection (p = 0.011) was recorded after the application of the therapy, as well as a drop in urine infection caused by the G– bacterial agent (p = 0.057).

Keywords:
bacterial infection – liver cirrhosis – varicose hemorrhage

Sources

1. Jirásek V. Gastroenterologie. In: Klener P et al. Vnitřní lékařství. Praha: Galén 1999: 437-519.

2. Sandel MH. Nonvariceal upper GI bleeding: differences in outcome for patients admitted to internal medicine and gastrointestinal services. Am J Gastroenterol 2000; 95: 2357-2362.

3. Zavoral M, Mařatka Z. Krvácení do trávicího ústrojí. In: Mařatka Z. Gastroenterologie. Praha: Karolinum 1999: 435-446.

4. Gurlich R, Lukáš K. Krvácení z dolní části trávicí trubice. Prakt Lék 2000; 80: 191-194.

5. Rockall TA, Logan RFA, Devlin HB et al. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the UK. British Medical Journal 1995; 311: 222-226.

6. Dítě P, Wechsler J, Novotný I et al. Gastroenterologická problematika v intenzivní medicíně. In: Ševčík P, Černý V, Vítovec J et al. Intenzivní medicína. Praha: Galén 2000: 122-126.

7. Lichtenstein DR, Berman MD, Wolfe MM. Approach to the patient with acute upper gastrointestinal hemorrhage,. In: Taylor MB Gastrointestinal emergencies. Philadelphia: Williams & Wilkins 1997: 99-129.

8. Bracy W, Peterson WL. Medical therapy of nonvariceal upper gastrointestinal hemorrhage,. In: Taylor MB Gastrointestinal emergencies. Philadelphia: Williams&Wilkins 1997: 151-162.

9. Zuccaro G jr. Management of the adult patient with acute lower gastrointestinal bleeding. Amer J Gastroenterol 1998; 8: 1202-1208.

10. Dražná E, Kment M. Endoskopická terapie při krvácení do trávicího traktu,. In: Mařatka Z et al. Aktuality v gastroenterologii. Praha: AZ Servis 1994: 116-138.

11. D´Amico G, Pagliaro L, Bosch J. Pharmacological treatment of portal hypertension: an evidence-based approach. Semin Liver Dis 1999; 19: 475-505.

12. Bosch J, Abraldes JG, Groszmann R. Current management of portal hypertension. J Hepatol 2003; 38: 554-568.

13. Rimola A, Garcia-Tsao G, Navasa M et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. J Hepatol 2000; 32: 142-153.

14. De Franchis R (ed). Portal Hypertension III. Proceedings of the third Baveno international consensus workshop on definitions, methodology and therapeutic strategies. Oxford: Blackwell Science, 2001.

15. Jalan R, Hayes PC. UK guidelines on the management of variceal hemorrhage in cirrhotic patients. Gut 2000; 46: 846-852.

16. The North Italien Endoscopic Club for the Study and Treatment of Esophageal Varices: Predictors of first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices: a prospective, multicentr trial. N Engl J Med 1988; 319: 983-989.

17. Goulis J, Patch D, Burroughs AK Bacterial infection in the pathogenesis of variceal bleeding. Lancet 1999; 353: 139-142.

18. Bernard B, Cadranel JF, Valla D et al. Prognostic significance of bacterial infection in bleeding cirrhotic patients: a prospective study. Gastroenterology 1995; 108: 1828-1834.

19. Blaise M, Paterton D, Trinchet JCP et al. Systemic antibiotic therapy prevents bacterial infections in cirrhotic patients with gastrointestinal hemorrhage. Hepatology 1994; 20: 34-38.

20. Vivas S, Rodriquez M, Palacio MA et al. Presence of bacterial infection in bleeding cirrhotic patients is independently associated with early mortality and failure to control bleeding. Dig Dis Sci 2001; 46: 2752- 2756.

21. Campillo B. Nosocomial spontaneous bacterial peritonitis and bacteremia in cirrhotic patients. Clin Infect Dis 2002; 35: 1-10.

22. Deschenes M, Villeneuve JP. Risk factors for the development of bacterial infections in hospitalized patients with cirrhosis. Am J Gastroenterol 1999; 94: 2193-2197.

23. Bleichner G, Boulanger R, Sguara P et al. Frequency of infections in cirrhotic patients presenting with acute gastrointestinal hemorrhage. Br J Surg 1986; 73: 724-726.

24. Navasa M, Rimola A, Rodes J et al. Bacterial infections in liver disease. Seminars in Liver Disease 1997; 17: 323-333.

25. Kienslichová E. Sepse u nemocných s jaterním selháním. Bulletin HPB 2002; 10: 63-66.

26. Thulstrup AM. Population-based study of the risk and short-term prognosis for bacteremia in patients with liver cirrhosis. Clin Infect Dis 2000; 31: 1357-1361.

27. Rimola A, Bory F, Teres J et al. Oral, nonabsorbale antibiotics prevent infection in cirrhotic with gastrointestinal hemorrhage. Hepatology 1985; 5: 463-467.

28. Zbořil V. Fyziologie mikroflóry trávicího traktu. Vnitř Lék 2002; 48: 17-21.

29. Cirera I, Bauer TM, Navasa M et al. Bacterial translocation of enteric organismus in patients with cirrhosis. J Hepatol 2001; 34: 32-37.

30. Bernard B, Grande JD, Khac EN et al. Antibiotic profylaxis for the prevention of bacterial infection in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology 1999; 29: 1655-1661.

31. Fernández J, Navasa M, Gómez J et al. Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin profylaxis. Hepatology 2002; 35: 140-148.

32. Navasa M, Fermández J, Rodés J. Prophylaxis of spontaneous bacterial peritonitis. The problem of spontaneous bacterial peritonitis by quinolone-resistant bacteria. In: Arroyo V, Bosch J, Bruix J et al. Therapy in Hepatology. Barcelona: Ars Medica 2001: 65-71.

33. Goulis J, Armonis A, Patch D et al. Bacterial infection is independently associated with failure control bleeding in cirrhotic patients with gastrointestinal hemorrhage. Hepatology 1998; 27: 1207-1212.

34. Berzigotti A, Garcia-Pagán JC, Bosch J. Therapy of acute variceal bleeding. In: Arroyo V, Bosch J, Bruix J et al. Therapy in hepatology Barcelona: Ars Medica 2001: 3-16.

35. Rodriguez LAG, Stricker BH, Zimmerman HJ. Risk of acute liver injury associated with the combination of amoxicillin and clavulanic acis. Arch Intern Med 1996; 156: 1327-1332.

36. Verhamme M, Ramboer C, Van De Bruane P et al. Cholestatic hepatitis due to an amoxycillin/clavulanic acid preparation. J Hepatol 1989; 9: 260-264.