Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy.
Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Dig Liver Dis. 2018 Apr;50(4):366-369. doi: 10.1016/j.dld.2017.12.012. Epub 2017 Dec 20.
Patients with cirrhosis are at high risk of bacterial infections. Invasive procedures are generally believed to increase this susceptibility.
We investigated the incidence of bacterial infections in cirrhotic patients undergoing elective endoscopic variceal ligation (EVL).
We enrolled 60 consecutive cirrhotic patients who underwent a total number of 112 elective EVL procedures. One to seven bands were applied at each session until variceal eradication. Markers of inflammation/infection and blood cultures were obtained before and 24 h after EVL.
Aetiology of liver disease was metabolic in 27 (45%), viral in 21 (35%), alcoholic in 12 (20%) patients. Child-Pugh class A/B/C distribution was 29/26/5, respectively, 23 (38%) patients had ascites and 15 (25%) had hepatocellular carcinoma. Blood cultures were negative in all samples before EVL, whereas 3/112 (2.7%) cultures tested positive after endoscopy. Streptococcus mitis and Staphylococcus epidermidis were isolated in 1 and 2 cases, respectively. None of these three patients developed any features of clinically relevant infection, suggesting that the positive cultures were an expression of a transient bacteraemia with no clinical sequelae.
Bacterial infection is an uncommon occurrence after elective EVL in cirrhotic patients, and antibiotic prophylaxis is not necessary in this clinical setting.
肝硬化患者存在发生细菌感染的高风险。一般认为，侵入性操作会增加这种易感性。
我们调查了行择期内镜下食管静脉曲张套扎术（EVL）的肝硬化患者发生细菌感染的发生率。
我们纳入了 60 例连续的肝硬化患者，他们总共进行了 112 次择期 EVL 操作。每次治疗时应用 1 到 7 个套扎环，直到静脉曲张消除。在 EVL 之前和之后 24 小时采集炎症/感染标志物和血培养。
肝脏疾病的病因在 27 例（45%）患者中为代谢性，在 21 例（35%）患者中为病毒性，在 12 例（20%）患者中为酒精性。Child-Pugh 分级 A/B/C 的分布分别为 29/26/5，23 例（38%）患者有腹水，15 例（25%）患者有肝细胞癌。在 EVL 之前所有样本的血培养均为阴性，而在 112 次内镜检查后有 3/112 次（2.7%）培养结果阳性。在 1 例和 2 例中分别分离出缓症链球菌和表皮葡萄球菌。这 3 例患者均未出现任何具有临床意义的感染特征，表明阳性培养结果是无临床后果的短暂菌血症的表现。
在肝硬化患者行择期 EVL 后，细菌感染并不常见，在这种临床情况下不需要抗生素预防。
