Gulberg V, Deibert P, Ochs A, Rossle M, Gerbes A L
Department of Medicine II, Klinikum Grosshadem, University of Munich, Germany.
Hepatogastroenterology. 1999 Mar-Apr;46(26):1126-30.
BACKGROUND/AIMS: Patients with cirrhosis of the liver are prone to bacterial infections. Therapeutic interventions such as endoscopic sclerotherapy increase the risk of bacterial infections in these patients. Following insertion of a transjugular intrahepatic portosystemic shunt (TIPS), the incidence of severe bacterial infections was recently shown to be 20% after elective procedures. This finding suggests antibiotic prophylaxis with the TIPS procedure. Antibiotic prophylaxis using cefotiam or cefotaxime/ampicillin did not significantly reduce infectious complications. The aim of the present study was therefore to investigate the efficacy of two different doses of a long-acting cephalosporin in prevention of bacterial infection after TIPS.
Eighty-two patients with cirrhosis (age: 52 +/- 2 years) who underwent elective TIPS were randomized to receive a single i.v. dose of either 1 g or 2 g Ceftriaxone 1 hour before the intervention. Patients with evidence of or suspected infections and patients on antibiotic therapy within 7 days prior to TIPS were excluded. Body temperature was monitored t.i.d. for 1 week and white blood count (WBC) and C-reactive protein (CRP) were determined before TIPS and 1 day and 1 week after TIPS.
Only 2 of 82 patients (2.6%) showed signs of infection following TIPS insertion: One of 40 patients receiving 1 g Ceftriaxone and 1 of 42 patients receiving 2 g Ceftriaxone prior to TIPS developed temperature > 38.5 degrees C. In the latter patient this was due to pneumonia. This patient received antibiotic treatment with imipenem for 10 days. Temperature in the other patient normalized within 12 hours and he did not require antibiotic treatment. No significant differences in temperature, WBC and CRP between the different doses of Ceftriaxone were observed.
Prophylactic treatment with Ceftriaxone reduces the reported incidence of bacterial infections after TIPS in patients with cirrhosis of the liver. Prophylaxis with 1 g Ceftriaxone seems as efficacious as 2 g.
背景/目的：肝硬化患者易发生细菌感染。诸如内镜硬化治疗等治疗干预措施会增加这些患者发生细菌感染的风险。最近研究显示，在进行经颈静脉肝内门体分流术（TIPS）后，择期手术患者中严重细菌感染的发生率为20%。这一发现提示在TIPS手术中应进行抗生素预防。使用头孢替安或头孢噻肟/氨苄西林进行抗生素预防并不能显著降低感染并发症的发生率。因此，本研究的目的是探讨两种不同剂量的长效头孢菌素在预防TIPS术后细菌感染中的疗效。
82例接受择期TIPS的肝硬化患者（年龄：52±2岁）被随机分为两组，在干预前1小时分别静脉注射1 g或2 g头孢曲松。排除有感染证据或疑似感染的患者以及在TIPS术前7天内接受抗生素治疗的患者。术后连续3天每天监测体温1周，并在TIPS术前、术后1天和1周测定白细胞计数（WBC）和C反应蛋白（CRP）。
82例患者中只有2例（2.6%）在TIPS术后出现感染迹象：40例术前接受1 g头孢曲松治疗的患者中有1例，42例术前接受2 g头孢曲松治疗的患者中有1例体温>38.5℃。后一例患者的发热是由肺炎引起的。该患者接受亚胺培南抗生素治疗10天。另一例患者的体温在12小时内恢复正常，无需抗生素治疗。不同剂量头孢曲松之间在体温、WBC和CRP方面未观察到显著差异。
头孢曲松预防性治疗可降低肝硬化患者TIPS术后报告的细菌感染发生率。1 g头孢曲松预防似乎与2 g一样有效。
