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Antibiotic Prophylaxis Variceal Bleed — SCE Infectious Diseases MCQ

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ModerateHepatitisAntibiotic Prophylaxis Variceal BleedSCE Infectious Diseases

A 40-year-old man with cirrhosis and known oesophageal varices is admitted with a massive upper GI bleed. After variceal banding and resuscitation, he develops fever at 48 hours. Blood cultures are positive for Streptococcus pneumoniae. What is the explanation for spontaneous bacteraemia in this clinical context?

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Correct answer: E — Cirrhosis-associated immune dysfunction plus variceal bleeding — GI haemorrhage in cirrhosis is an independent risk factor for bacterial infection; antibiotic prophylaxis during variceal bleeds reduces infection and mortality

GI haemorrhage in cirrhotic patients is independently associated with a 20–50% risk of bacterial infection within 7 days, due to bacterial translocation across a damaged GI mucosa into the portal and systemic circulation. This is compounded by cirrhosis-associated immune dysfunction. Current guidelines (EASL, BSG) recommend prophylactic antibiotics for ALL cirrhotic patients with GI haemorrhage: IV Ceftriaxone 1 g daily for up to 7 days. This reduces infection rates, rebleeding, and mortality.

Reference: EASL 2024 – Decompensated cirrhosis; BSG 2021 – Variceal bleeding