S1410 Evaluating the Role of Antimicrobial Prophylaxis in Child-Pugh A/B Cirrhosis With Upper GI Bleeding: Insights From a Multicenter Retrospective Study

Introduction: Upper gastrointestinal bleeding (UGIB) in cirrhosis patients presents a considerable risk of infectious complications and mortality. Antimicrobial prophylaxis is advocated to prevent infections; however, its efficacy in Child-Pugh (CP) class A and B patients remains uncertain. This study evaluated the impact of antimicrobial prophylaxis on outcomes of UGIB among cirrhotic CP class A/B patients with UGIB. Methods: Patients with CP class A/B cirrhosis hospitalized for UGIB at 2 Rochester Regional Health hospitals from January 2020 - March 2024 were enrolled retrospectively. Patients with CP class C cirrhosis and those with bacterial infections were excluded. Patients were stratified into 2 groups based on antimicrobial prophylaxis receipt. Outcomes evaluated included infection incidence within 30 days, rebleeding during hospitalization, in-hospital mortality, 30-day mortality, and 30-day readmission rates. Results: We included 150 cirrhotic patients (CP class A or B) admitted for UGIB, of whom 101 received antimicrobial prophylaxis, while 49 did not. Of patients who received antimicrobial prophylaxis, a higher proportion had variceal bleeding as the etiology for bleeding compared to those who did not receive antimicrobial prophylaxis (64.4% vs 44.9%, P = 0.02). A moderate to large amount of ascites was more prevalent in the prophylaxis group compared to those without prophylaxis (27.72% vs 10.20%, P = 0.02), with no other notable differences in baseline characteristics. Outcome analysis indicated lower infection rates in the prophylaxis group (11.9%) compared to the non-prophylaxis group (18.4%), although this difference was not statistically significant (OR 0.58, 95% CI 0.22–1.55, P = 0.28). There were no significant differences between the groups in terms of rebleeding rates, in-hospital mortality, 30-day mortality, and 30-day readmission. Conclusion: Antimicrobial prophylaxis in CP class A and B cirrhotic patients admitted with UGIB was associated with a nonsignificant reduction in overall infection rates without impacting rebleeding, mortality or readmission. These findings suggest that antibiotic treatment administered as needed may be adequate for patients with CP class A/B cirrhosis experiencing UGIB. However, prospective studies with larger sample sizes are warranted to validate our findings and inform clinical practice guidelines.