The effect of prophylactic antibiotics in acute upper gastrointestinal bleeding patients in the emergency department

BACKGROUND: Currently, prophylactic antibiotics are recommended only for cirrhotic patients with acute upper gastrointestinal bleeding(AUGIB);however, the benefit for other AUGIB patients remains undetermined. We aimed to compare the clinical outcomes between patients with AUGIB with and without prophylactic antibiotics to identify the population that requires this therapy.METHODS: Patients with AUGIB admitted between 1st January 2019 and 31st December 2021 in the Emergency Department of Peking Union Medical College Hospital were enrolled. Patients were divided into the antibiotic and non-antibiotic groups. The primary outcome was in-hospital mortality, and the secondary outcome was the onset of new infection. The risk factors for mortality and infection were analyzed, and stratification analysis of prophylactic antibiotics was performed. Continuous data were analyzed using the t-test or nonparametric rank sum test, and categorical data were analyzed using the Chi-square test or Fisher's exact test. Indicators with significant differences between the groups were included for logistic regression analysis. A P-value <0.05 was considered statistically significant. RESULTS: A total of 392 individuals were included, among them, 281 patients received prophylactic antibiotics, and 111 patients did not receive prophylactic antibiotics. The mortality rates were significantly lower in the antibiotic group than in the non-antibiotics group(6.41% vs. 17.12%, P=0.001). The risk factors for infection were varicose veins(P=0.045) and endotracheal intubation(P=0.005) in the prophylactic antibiotic group, and endoscopic treatment(P=0.010) in the non-prophylactic antibiotic group. Stratified analyses showed that patients with age ≥ 65 years, endotracheal intubation, endoscopic treatment, and AUGIB of variceal etiologies benefited from prophylactic antibiotics.CONCLUSION: AUGIB patients may benefit from prophylactic antibiotics to decrease mortality, especially those aged ≥ 65 years and those with endotracheal intubation, endoscopic treatment, and variceal etiologies.

The role of prophylactic antibiotics in hepatitis B virus-related acute-on-chronic liver failure patients at risk of bacterial infection: a retrospective study

Background:Acute-on-chronic liver failure(ACLF)is characterized by an excessive systemic inflammatory response and organ failure and has high mortality.Bacterial infections(Bis)worsen the clinical course of ACLF and carry a poor prognosis in ACLF patients.The efficacy of third-generation cephalosporins has been challenged in recent years.The aim of this study was to characterize the difference between ACLF patients with and without Bis and to provide a reference for medical intervention.

Enteromorpha polysaccharide-zinc replacing prophylactic antibiotics contributes to improving gut health of weaned piglets

This research aimed to study whether Enteromorpha polysaccharide-zinc(EP-Zn)can act as an alternative to antibiotics in weaned piglet feeds.Two hundred and twenty-four weaned piglets from 14 pens were randomly assigned into 1 of 2 groups according to their body weight and litter size(7 pens/group).The piglets in the antibiotics group were fed with olaquindox at 400 mg/kg and enduracidin at 800 mg/kg basal diet,and piglets in the EP-Zn group were fed with EP-Zn at 800 mg/kg basal diet.One piglet per pen was selected to collect samples after 14 d of feeding.Results showed that EP-Zn supplementation significantly increased the plasma anti-oxidants level compared with the antibiotics group.However,a nonsignificant difference was observed in growth performance between treatment groups.Additionally,the intestinal tight junction(TJ)protein expression and the histopathologic evaluation data showed that EP-Zn contributed to improving intestinal development.Further,piglets in the EP-Zn group had a lower level of intestinal inflammation-related cytokines including IL-6(P<0.001),IL-8(P<0.05),IL-12(P<0.05)and tumor necrosis factor-α(TNF-α)(P<0.001),and showed an inhibition of the phosphor-ylation nuclear transcription factor-kappa B(p-NF-kB)(P<0.05)and total NF-kB(P<0.001)level in the jejunal mucosa.Taken together,it is supposed that EP-Zn,to some extent,would be a potent alternative to prophylactic antibiotics in improving the health status of weaned piglets.

Antibiotic Prescribing Patterns and Prevalence of Surgical Site Infections in Caesarean Section Deliveries at Two Tertiary Hospitals in Lusaka, Zambia

Introduction: A caesarean section (CS) is one of the most frequently performed obstetric surgeries in the world and its use has increased dramatically in recent years. The number of caesarean section cases worldwide has been increasing each year, and the World Health Organization (WHO) reported an excess of 10% - 15% of CS procedures for all births. However, some women experience surgical site infections (SSIs) after undergoing CS delivery. This study investigated the prescribing patterns of antibiotics in CS deliveries and the prevalence of SSIs at two tertiary hospitals in Lusaka, Zambia. Materials and Methods: A retrospective cross-sectional study was conducted from January 2020 to December 2020 at the Women and Newborn University Teaching Hospital (UTH) and the Levy Mwanawasa University Teaching Hospital, in Lusaka, Zambia. Results: Of a total of 838 women who delivered via CS, more than half were aged between 21 and 25 years (n = 461, 55.0%), 56.3% were from low-cost residential areas, and 57% had emergency CS delivery. The prevalence of SSIs was 6.0%, with the level of education (OR 0.377, 95% CI 0.150 - 0.946), type of caesarean section (OR 6.253, 95% CI 2.833 - 13.803), and oral antibiotics post-caesarean (OR 0.218, 95% CI 0.049 - 0.963). The duration of IV antibiotic treatment significantly predicted SSI (p Conclusion: This study found that the third-generation cephalosporin (cefotaxime) and triple combination therapy (benzylpenicillin, gentamicin, and metronidazole) were the most frequently prescribed antibiotics before and after CS. The level of education, type of CS, oral antibiotics post-CS, facility, and duration of administering IV antibiotics were all predictors of SSIs.

The impact of single-prophylactic antibiotic dministration on post-infection and outcome of endovascular aortic repair

Background It is unclear whether the efficacy of single prophylactic antibiotic administration has an impact on infection and death in patients with Aortic Dissection of Stanford B treated by Endovascular Aortic Repair （EVAR）. Methods According to whether or not received antibiotics prophylaxis, patients were divided into two groups： the single prophylactic antibiotic group （Group A） and non-prophylactic antibiotic group （Group B）. Procalcitonin （PCT） and other clinical data were obtained with follow-up for one year. Results A total of 201 patients were screened. Among which, 70 patients received single antibiotic administration and 131 patients did not. 31（44.3%） patients had fever in group A while 81（61.8%） patients had fever in group B after EVAR （P=0.017）. The PCT and C-reactive protein （CRP） were significantly different between the two group： 0.18 ± 0.31 vs. 0.76 ± 1.18（ng/mL） （P=0. 000）, 81.35 ± 31.83 vs. 105.02 ± 60.37（mg/mL） （P=0.000）, respectively. By comparison of incidences of postoperative infection, 4（5.7%） patients were infected in Group A while 26（19.8%） patients were infected in Group B （P=0.007）. In infected group, the PCT in group A was 1.04±0.82 while that in Group B was 2.67±1.28 （P=0.015）. In non-infected group, the PCT in group A was 0.12±0.14 while that in Group B was 0.29± 0.44 （P=0.005）. Finally, One-year mortality in group A was 2（2.9%） while that in Group B （P=0.037） was 15 （11.5%）. Conclusion Single prophylactic antibiotic administration can significantly reduce the incidences of postoperative infection and affect the prognosis after EVAR.