Antibiotic use in cirrhotic children with acute upper gastrointestinal bleeding: A retrospective study using the pediatric health information system (PHIS) database

Lina Castillo, Sittichoke Prachuapthunyachart, Mel Hall, Shaija Shelby, Ruben E. Quiros-Tejeira, Hanh D. Vo

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Abstract

Prior studies have demonstrated positive impacts of antibiotic use on reducing mortality, rebleeding events, and length of hospitalization in adult cirrhotic patients with acute upper gastrointestinal bleeding (UGIB). We aimed to investigate the use of antibiotics in cirrhotic children with acute UGIB and its impact on patient outcomes.This was a retrospective study using the Pediatric Health Information System database. Cirrhotic patients aged 0 to 18 years with acute UGIB, admitted between October 2005 and September 2015, were identified based on ICD-9 codes. Patients with no documented endoscopy during admission were excluded.Forty-four (23 females) cirrhotic children were eligible for data analysis. The median patient age was 6 years. Etiology of acute UGIB included esophageal varices (n = 37), non-variceal bleeding (n = 4), and both (n = 3). A significant proportion of cirrhotic children with acute UGIB (n = 30, 68%) were given intravenous antibiotics within 48 hours of admission. Among children who did not develop bacteremia, 68% received antibiotics vs. 32% who did not (P = .6). The rate of readmission within 30 days of discharge was 7% in patients with antibiotics vs. 21% in those without antibiotics (P = .3).This study suggested that antibiotic use within 48 hours of admission in cirrhotic children with acute UGIB might have a positive impact on the percentage of children free of bacteremia and the readmission rate. A prospective study should investigate whether prophylactic antibiotics should be targeted only to a subgroup of cirrhotic children with acute UGIB who are particularly at high risk for bacterial infection.

Original languageEnglish (US)
Pages (from-to)e16505
JournalMedicine
Volume98
Issue number29
DOIs
StatePublished - Jul 1 2019

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Health Information Systems
Retrospective Studies
Databases
Pediatrics
Hemorrhage
Anti-Bacterial Agents
International Classification of Diseases
Bacteremia
Esophageal and Gastric Varices
Bacterial Infections
Endoscopy
Hospitalization
Prospective Studies
Mortality

ASJC Scopus subject areas

  • Medicine(all)

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Antibiotic use in cirrhotic children with acute upper gastrointestinal bleeding : A retrospective study using the pediatric health information system (PHIS) database. / Castillo, Lina; Prachuapthunyachart, Sittichoke; Hall, Mel; Shelby, Shaija; Quiros-Tejeira, Ruben E.; Vo, Hanh D.

In: Medicine, Vol. 98, No. 29, 01.07.2019, p. e16505.

Research output: Contribution to journalArticle

Castillo, Lina ; Prachuapthunyachart, Sittichoke ; Hall, Mel ; Shelby, Shaija ; Quiros-Tejeira, Ruben E. ; Vo, Hanh D. / Antibiotic use in cirrhotic children with acute upper gastrointestinal bleeding : A retrospective study using the pediatric health information system (PHIS) database. In: Medicine. 2019 ; Vol. 98, No. 29. pp. e16505.
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abstract = "Prior studies have demonstrated positive impacts of antibiotic use on reducing mortality, rebleeding events, and length of hospitalization in adult cirrhotic patients with acute upper gastrointestinal bleeding (UGIB). We aimed to investigate the use of antibiotics in cirrhotic children with acute UGIB and its impact on patient outcomes.This was a retrospective study using the Pediatric Health Information System database. Cirrhotic patients aged 0 to 18 years with acute UGIB, admitted between October 2005 and September 2015, were identified based on ICD-9 codes. Patients with no documented endoscopy during admission were excluded.Forty-four (23 females) cirrhotic children were eligible for data analysis. The median patient age was 6 years. Etiology of acute UGIB included esophageal varices (n = 37), non-variceal bleeding (n = 4), and both (n = 3). A significant proportion of cirrhotic children with acute UGIB (n = 30, 68{\%}) were given intravenous antibiotics within 48 hours of admission. Among children who did not develop bacteremia, 68{\%} received antibiotics vs. 32{\%} who did not (P = .6). The rate of readmission within 30 days of discharge was 7{\%} in patients with antibiotics vs. 21{\%} in those without antibiotics (P = .3).This study suggested that antibiotic use within 48 hours of admission in cirrhotic children with acute UGIB might have a positive impact on the percentage of children free of bacteremia and the readmission rate. A prospective study should investigate whether prophylactic antibiotics should be targeted only to a subgroup of cirrhotic children with acute UGIB who are particularly at high risk for bacterial infection.",
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