S2748 Physicians' Practice Patterns in Adhering to AASLD Antibiotic Prophylaxis Guidelines for GI Bleeding in Cirrhosis: A Retrospective Analysis

Introduction: Upper gastrointestinal bleeding (UGIB) in patients is a serious, potentially life-threatening condition, often resulting in significant morbidity and mortality. Current guidelines emphasize the importance of timely administration of antibiotic prophylaxis, vasoactive therapy in case of variceal bleeding, and early endoscopic evaluation and intervention. While adherence to these treatment components ensures improved patient outcomes, studies show that adherence in real-world settings is often suboptimal. The aim of this study is to assess the degree of adherence to the established guidelines in a community hospital. Methods: Patients with Cirrhosis hospitalized for UGIB between January 2020 and March 2024 were enrolled retrospectively after excluding patients with active bacterial infections. Data were collected on demographics, Child-Pugh classification, and various components of UGIB management. Results: The study encompassed 192 cirrhotic patients who were admitted for UGIB, with a mean age of 58.63 years. The cohort predominantly consisted of White men, with alcohol consumption identified as the most common etiological factor for cirrhosis. Among these patients, only 131 individuals (68.23%) received prophylactic antibiotics within 24 hours of admission, with a notably lower proportion for non-variceal bleeding (NVB) compared to variceal bleeding (VB). Of the patients with VB (n = 109), a mere 72.48% were administered somatostatin analogues within 24 hours, only 41.28% underwent esophagogastroduodenoscopy (EGD) within 12 hours of presentation, and intravenous proton pump inhibitors (PPI) were discontinued in only 4.56% of patients within 24 hours following an EGD (that was negative for any evidence of non-variceal bleeding). Furthermore, among patients with VB who were not on beta-blockers, only 49.21% were prescribed nonselective beta-blockers prior to discharge. Conclusion: Despite established recommendations, there are notable gaps in adherence, particularly concerning the administration of prophylactic antibiotics, early EGD, de-escalation of PPI, and the prescription of beta-blockers for secondary prophylaxis in VB. Interventions, including enhanced education for medical practitioners and the implementation of a customized order set in the electronic medical record (EMR), are planned. The subsequent phase will assess improvements in adherence to management guidelines post-intervention.