‘No evidence’ antibiotics prevent hospital-acquired infections in cirrhosis patients
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Antibiotic prophylaxis failed to reduce the incidence of hospital-acquired infections or overall mortality among patients with decompensated cirrhosis, according to data published in The American Journal of Gastroenterology.
“We undertook this study as we were struck that clinicians in our large-scale trial Albumin to Prevent Infection in Chronic Liver Failure (ATTIRE) prescribed antibiotics to more than 50% of patients at hospitalization even though they only thought 27% had an infection,” Alastair O’Brien, MBBS, BSc, FRCP, PhD, professor of experimental hepatology and clinical director of the Comprehensive Clinical Trials Unit at University College London, told Healio. “Infection is a major problem in patients with cirrhosis, with patients both highly susceptible to infection and highly likely to develop sepsis.”
Concerned about antimicrobial resistance “driven in part by antibiotic over-prescription,” O’Brien and colleagues sought to investigate whether antibiotics prescribed to patients without existing infection prevented hospital-acquired infection or improved survival.
Researchers analyzed data from 563 patients without active infection at trial entry, of whom 203 received antibiotics and were described as “more unwell” than noninfected patients who were not given antibiotics. The primary outcome of interest was incidence of hospital-acquired infections (HAI) on days 3 through 15 among patients prescribed antibiotics at baseline.
According to results, there was no difference in subsequent HAI among antibiotic-treated patients (19.2%) vs. nonantibiotic-treated patients (20.3%), although there was a higher rate of 28-day mortality among those treated with antibiotics, likely due to disease severity. Researchers reported no difference in HAI or mortality in noninfected patients treated with or without rifaximin at enrollment.
“We found no evidence that prescribing antibiotics to hospitalized cirrhosis patients who were not considered to have an active infection prevented development of HAI, nor mortality overall, although there may be a benefit in those with a serum white cell count greater than 11,” O’Brien said. “These data demonstrate an overall lack of efficacy for antibiotic prescribing in the absence of infection to prevent HAI in decompensated cirrhosis, despite this being common practice in the United Kingdom.”
Additional analysis demonstrated no difference in 6-month mortality among patients prescribed long-term antibiotic prophylaxis at discharge compared with patients who were not prescribed antibiotics.
“We suggest that infection guidelines and care bundles should include prompt de-escalation or discontinuation of empirically prescribed antibiotics guided by culture sensitivities at 24 to 48 hours after commencement if no infection and an improving patient, and restricting prophylaxis use to evidence-based indications,” O’Brien told Healio. “Greater evidence is needed to recommend rifaximin use to prevent HAI.”
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