Cefazolina vs. ciprofloxacino en la profilaxis de infecciones en pacientes cirróticos con sangrado digestivo / Ciprofloxacin vs cefazolin in the prevention of infection in cirrhotic patients with gastrointestional bleeding

OBJETIVO: Determinar si el uso de Cefazolina como profilaxis antibiótica produce una disminución significativa de las infecciones en pacientes cirróticos con sangrado digestivo, comparado con Ciprofloxacino. Material y MétodoS: Ensayo Clínico aleatorizado. Se incluyeron a pacientes cirróticos mayores de 18 años, con sangrado digestivo, que ingresaron entre Julio del 2008 a julio del 2010 a la Unidad de hemorragia Digestiva del HNERM, sin evidencia clínica ni de laboratorio de infección al momento del ingreso y que no hubieran recibido tratamiento antibióticolas últimas 2 semanas. A un grupo se le administró Ciprofloxacino 200 mg bid EV y al otro Cefazolina 1 g tid EV.x 7 dias. RESULTADOS: Fueron incluidos 98 pacientes, 53 pacientes en el grupo de Cefazolina y 45 en el grupo de Ciprofloxacino. El promedio de edad fue 66 +/- 10 años, 61 % varones; 59,2 % tuvieron ascitis, la frecuencia de infecciones en la población total fue de 14,3% (14/98). El resangrado fue 8,1% y la mortalidad general 4,1%. No hubo diferencias significativas entre los grupos en relación a edad, sexo, estadio Child, ascitis, encefalopatía, ni en promedio de Bilirrubina, TP, Creatinina y niveles de Albúmina. El grupo que usó Cefazolina tuvo 11,3 % de infecciones, comparado con el 17,8% de infecciones en el grupo que recibió Ciprofloxacino (p= 0,398) IC 95%. Cuando se excluyó del análisis los pacientes cirróticos Child A y aquellos sin ascitis, se encontró: 22,2 % de infecciones en el grupo de cefazolina y 26,9 % en el grupo de Ciprofloxacino (p=0,757 IC 95%).

AIM: To determine if prophylaxis with cefazolin produces a significant reduction in infections in cirrhotic patients with gastrointestinal bleeding when compared with ciprofloxacin. METHODS: Randomized clinical trial. Patients 18 years or older with diagnosis of cirrhosis, gastrointestinal bleeding and no clinical or laboratory evidence of infection who were admitted to the gastrointestinal bleeding unit of HNERM between July 2008 and July 2010 were included. Patients were allocated to receive either i.v. ciprofloxacin 200 mg bid or i.v. cefazolin 1 gm tid for 7 days. RESULTS: 98 patients were included, 53 in the cefazolin group and 45 in the ciprofloxacinone. Age average was 66 +/- 10 years, 61% were male, 59,2% had ascites. Overall rate of infections was 14,3% (14/98). Rebleeding rate was 8,1% and mortality 4,1%. There were nodifferences in age, sex, Child Pugh score, ascites, hepatic encephalopathy nor in billirubin, albumin, PT and creatinine levels between the study groups. Infection rate in the cefazolin groups was 11,3% while in the ciprofloxacin one 17,8% (p=0,398). When Child-Pugh A and patients without ascites were excluded of the analysis, the cefalozin group had 22,2% of infections and 26,9% in the ciprofloxacin one (p=0,757).

[Ciprofloxacin vs cefazolin in the prevention of infection in cirrhotic patients with gastrointestinal bleeding]. / Cefazolina vs. Ciprofloxacino en la Profilaxis de Infecciones en Pacientes Cirróticos con Sangrado Digestivo.

AIM: To determine if prophylaxis with cefazolin produces a significant reduction in infections in cirrhotic patients with gastrointestinal bleeding when compared with ciprofloxacin. METHODS: Randomized clinical trial. Patients 18 years or older with diagnosis of cirrhosis, gastrointestinal bleeding and no clinical or laboratory evidence of infection who were admitted to the gastrointestinal bleeding unit of HNERM between July 2008 and July 2010 were included. Patients were allocated to receive either i.v. ciprofloxacin 200 mg bid or i.v. cefazolin 1 gm tid for 7 days. RESULTS: 98 patients were included, 53 in the cefazolin group and 45 in the ciprofloxacin one. Age average was 66 +/- 10 years, 61% were male, 59,2% had ascites. Overall rate of infections was 14,3% (14/98). Rebleeding rate was 8,1% and mortality 4,1%. There were no differences in age, sex, Child Pugh score, ascites, hepatic encephalopathy nor in billirubin, albumin, PT and creatinine levels between the study groups. Infection rate in the cefazolin groups was 11,3% while in the ciprofloxacin one 17,8% (p=0,398).When Child-Pugh A and patients without ascites were excluded of the analysis, the cefalozin group had 22,2% of infections and 26,9% in the ciprofloxacin one (p=0,757). CONCLUSION: there were no differences in infection rates between patients with prophylaxis with cefazolin and ciprofloxacin after an episode of gastrointestinal bleeding.

[Clinical and epidemiological profile of cirrhosis in the liver unit at Edgardo Rebagliati Martins National Hospital]. / Caracteristicas epidemiológicas y clínicas de la cirrosis hepática en la unidad de hígado del HNERM ES-SALUD.

BACKGROUND: Liver cirrhosis is an important cause of morbidity and mortality all around the world. In Peru it is the 5th cause of general mortality and the 2nd one between all those related to gastrointestinal and hepatobiliary diseases. At HNERM it is the principal etiology between all the cases that need hospitalization in gastroenterology. It is clear that we need to know all the clinical and epidemiologic characteristics to propose national actions to try to control and prevent this disease. MATERIAL AND METHODS: The present is a descriptive, transversal and observational study to clarify the clinical and epidemiological profile of patients with cirrhosis hospitalized in the Liver unit at the Edgardo Rebagliati Martins National Hospital between january 2001 and june 2004. RESULTS: 475 patients were included, 45.1% were female, medium age was 63.4 years (r =26-93). The most frequent causes of cirrhosis were alcoholism (28%), chronic hepatitis B (15.2%), and chronic hepatitis C (11.8%). According to Child-Pugh score 42.3% was in stage B, and 42.5% en C. The main cause for hospitalization was upper gastrointestinal bleeding related to portal hypertension, followed by ascitis and encephalopathy. The principal infections were urinary, pulmonar and spontaneous bacterial peritonitis. Hepatocellullar carcinoma was found in 7.9% of the cases. CONCLUSIONS: Liver cirrhosis affects principally males. The principal causes are alcoholism and chronic viral hepatitis. The principal cause of hospitalization is upper gastrointestinal bleeding. Most of the patients have an advanced disease at the moment of diagnosis. Principal infections are urinary, Pneumonia and SBP.