| Summary: | 碩士 === 中山醫學大學 === 公共衛生學系碩士班 === 101 === Patients with esophageal variceal bleeding are prone to having infections, which may aggravate rebleeding and increase mortality. However, the effects of antibiotic prophylaxis on mortality and medical cost in patients with esophageal variceal bleeding are not well described.
Purpose： This study aimed to evaluate the effect of antibiotic prophylaxis on the mortality and medical cost of patients hospitalized with esophageal variceal bleeding.
Method：De-identified patient data from the National Health Insurance Database, derived from the Taiwan National Health Insurance Program was reviewed, to enroll 1067 admissions for esophageal variceal bleeding and receiving endoscopic ligation between January 1, 2005 and 31 December, 2010. We collected patients’ demographic, medical cost and hospitalization data including hospital stays and conditions of discharging, and reviewed diagnostic codes to determine infectious diseases and comorbid disorders of their hospitalizations, then reviewed ATC codes to determine antibiotic prophylaxis in non-infection group. Patients were divided into an antibiotic prophylaxis group and non-prophylaxis group and odds ratios (ORs) were determined for hospital mortality.
Results：Of the total 1067 admissions for esophageal variceal bleeding and receiving endoscopic ligation, there were 819 admissions for esophageal variceal bleeding (EVB) without infection. Among the 819 admissions, prescription of antibiotics was placed into the prophylaxis group (n=392), and the remaining was placed into the non-prophylaxis group (n=427). The proportion of antibiotic prophylaxis in EVB admissions significantly increased with year from 39.5 % to 57.4% during 2005 to 2010 in non-infection admissions. But there was not significant difference between incidence of bacterial infection during the six years. More antibiotic prophylaxes were used in patients with malignant neoplasm of liver and intrahepatic bile ducts which is an independent risk factor of mortality in our analysis as other studies. ICU care and shock are significantly associated with mortality. After logistic regression analyses adjusted by the patients’ demographic and clinical characters, the odds ratio in patients with antibiotic prophylaxis for hospital mortality was 3.179 (95% confidence interval (CI) 1.627 - 6.210). Compared to the non-prophylaxis group, the ratios of hospital stay, total medical expense and prescription cost were 1.8, 2.5, and 2.4, respectively.
Conclusion：Antibiotic prophylaxis for patients with esophageal variceal bleeding did not reduce mortality. Mortality of non-infectious patients with esophageal variceal bleeding was significantly associated with the severity of illness (ICU care and shock) and hepatic malignancy.
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