Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis

Javier Martínez; Virginia Hernández-Gea; Enrique Rodríguez-de-Santiago; Luis Téllez; Bogdan Procopet; Álvaro Giráldez; Lucio Amitrano; Candid Villanueva; Dominique Thabut; Luis Ibañez-Samaniego; Gilberto Silva-Junior; Joan Genescà; Christophe Bureau; Jonel Trebicka; Rafael Bañares; Aleksander Krag; Elba Llop; Wim Laleman; Jose María Palazon; Jose Castellote; Susana Rodrigues; Lise L. Gluud; Carlos Noronha-Ferreira; Nuria Cañete; Manuel Rodríguez; Arnulf Ferlitsch; Remy Schwarzer; Jose Luis Mundi; Henning Gronbaek; Manuel Hernández-Guerra; Romano Sassatelli; Alessandra Dell'Era; Marco Senzolo; Juan G. Abraldes; Manuel Romero-Gomez; Alexander Zipprich; Meritxell Casas; Helena Masnou; Massimo Primignani; Frederik Nevens; Jose Luis Calleja; Christian Jansen; Marie Angèle Robic; Irene Conejo; Maria Vega Catalina; Marika Rudler; Edilmar Alvarado; Valeria Perez-Campuzano; Maria Anna Guardascione; Petra Fischer; International Variceal Bleeding Observational Study Group and Baveno Cooperation

doi:10.1016/j.jhep.2021.03.026

Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis

Javier Martínez, Virginia Hernández-Gea, Enrique Rodríguez-de-Santiago, Luis Téllez, Bogdan Procopet, Álvaro Giráldez, Lucio Amitrano, Candid Villanueva, Dominique Thabut, Luis Ibañez-Samaniego, Gilberto Silva-Junior, Joan Genescà, Christophe Bureau, Jonel Trebicka, Rafael Bañares, Aleksander Krag, Elba Llop, Wim Laleman, Jose María Palazon, Jose CastelloteSusana Rodrigues, Lise L. Gluud, Carlos Noronha-Ferreira, Nuria Cañete, Manuel Rodríguez, Arnulf Ferlitsch, Remy Schwarzer, Jose Luis Mundi, Henning Gronbaek, Manuel Hernández-Guerra, Romano Sassatelli, Alessandra Dell'Era, Marco Senzolo, Juan G. Abraldes, Manuel Romero-Gomez, Alexander Zipprich, Meritxell Casas, Helena Masnou, Massimo Primignani, Frederik Nevens, Jose Luis Calleja, Christian Jansen, Marie Angèle Robic, Irene Conejo, Maria Vega Catalina, Marika Rudler, Edilmar Alvarado, Valeria Perez-Campuzano, Maria Anna Guardascione, Petra Fischer, International Variceal Bleeding Observational Study Group and Baveno Cooperation

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Abstrakt

Background & Aims: Antibiotic prophylaxis reduces the risk of infection and mortality in patients with cirrhosis and acute variceal bleeding (AVB). This study examines the incidence of, and risk factors for, bacterial infections during hospitalization in patients with AVB on antibiotic prophylaxis. Methods: A post hoc analysis was performed using the database of an international, multicenter, observational study designed to examine the role of pre-emptive transjugular intrahepatic portosystemic shunts in patients with cirrhosis and AVB. Data were collected on patients with cirrhosis hospitalized for AVB (n = 2,138) from a prospective cohort (October 2013-May 2015) at 34 referral centers, and a retrospective cohort (October 2011-September 2013) at 19 of these centers. The primary outcome was incidence of bacterial infection during hospitalization. Results: A total of 1,656 patients out of 1,770 (93.6%) received antibiotic prophylaxis; third-generation cephalosporins (76.2%) and quinolones (19.0%) were used most frequently. Of the patients on antibiotic prophylaxis, 320 patients developed bacterial infection during hospitalization. Respiratory infection accounted for 43.6% of infections and for 49.7% of infected patients, and occurred early after admission (median 3 days, IQR 1-6). On multivariate analysis, respiratory infection was independently associated with Child-Pugh C (odds ratio [OR] 3.1; 95% CI 1.4-6.7), grade III-IV encephalopathy (OR 2.8; 95% CI 1.8-4.4), orotracheal intubation for endoscopy (OR 2.6; 95% CI 1.8-3.8), nasogastric tube placement (OR 1.7; 95% CI 1.2-2.4) or esophageal balloon tamponade (OR 2.4; 95% CI 1.2-4.9). Conclusion: Bacterial infections develop in almost one-fifth of patients with AVB despite antibiotic prophylaxis. Respiratory infection is the most frequent, is an early event after admission, and is associated with advanced liver failure, severe hepatic encephalopathy and use of nasogastric tube, orotracheal intubation for endoscopy or esophageal balloon tamponade. Lay summary: Bacterial infections develop during hospitalization in close to 20% of patients with acute variceal bleeding despite antibiotic prophylaxis. Respiratory bacterial infections are the most frequent and occur early after admission. Respiratory infection is associated with advanced liver disease, severe hepatic encephalopathy and a need for a nasogastric tube, orotracheal intubation for endoscopy or esophageal balloon tamponade.

Originalsprog	Engelsk
Tidsskrift	Journal of Hepatology
Vol/bind	75
Udgave nummer	2
Sider (fra-til)	342-350
ISSN	0168-8278
DOI	https://doi.org/10.1016/j.jhep.2021.03.026
Status	Udgivet - aug. 2021

Bibliografisk note

Funding Information:
Supported by grants from the Spanish Ministry of Science and Innovation ( SAF-2016-75767-R to JC.G-P, SAF 2017-86343-R awarded to A.A, Instituto de Salud Carlos III PIE 15/00027 to JC.G-P, PI17/00398 to V.H.G, PI18/01901 to R.B and PI20/01302 to A.A, and Commissioner for Universities and Research of the Generalitat de Catalunya ( AGAUR SGR 2017 awarded to JC.G-P). CIBEREHD is funded by the Instituto de Salud Carlos III with grants cofinanced by the European Development Regional Fund “A way to achieve Europe” (EDRF).

Funding Information:
Juan Carlos Garcia-Pagan has consultant fees for GORE, Shionogi and Cook grants from GORE and Novartis. Álvaro Giráldez has served as speaker for Gore.

Dokumenter og links

10.1016/j.jhep.2021.03.026

Citationsformater

Martínez, J., Hernández-Gea, V., Rodríguez-de-Santiago, E., Téllez, L., Procopet, B., Giráldez, Á., Amitrano, L., Villanueva, C., Thabut, D., Ibañez-Samaniego, L., Silva-Junior, G., Genescà, J., Bureau, C., Trebicka, J., Bañares, R., Krag, A., Llop, E., Laleman, W., Palazon, J. M., ... International Variceal Bleeding Observational Study Group and Baveno Cooperation (2021). Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis. Journal of Hepatology, 75(2), 342-350. https://doi.org/10.1016/j.jhep.2021.03.026

Martínez, Javier ; Hernández-Gea, Virginia ; Rodríguez-de-Santiago, Enrique ; Téllez, Luis ; Procopet, Bogdan ; Giráldez, Álvaro ; Amitrano, Lucio ; Villanueva, Candid ; Thabut, Dominique ; Ibañez-Samaniego, Luis ; Silva-Junior, Gilberto ; Genescà, Joan ; Bureau, Christophe ; Trebicka, Jonel ; Bañares, Rafael ; Krag, Aleksander ; Llop, Elba ; Laleman, Wim ; Palazon, Jose María ; Castellote, Jose ; Rodrigues, Susana ; Gluud, Lise L. ; Noronha-Ferreira, Carlos ; Cañete, Nuria ; Rodríguez, Manuel ; Ferlitsch, Arnulf ; Schwarzer, Remy ; Mundi, Jose Luis ; Gronbaek, Henning ; Hernández-Guerra, Manuel ; Sassatelli, Romano ; Dell'Era, Alessandra ; Senzolo, Marco ; Abraldes, Juan G. ; Romero-Gomez, Manuel ; Zipprich, Alexander ; Casas, Meritxell ; Masnou, Helena ; Primignani, Massimo ; Nevens, Frederik ; Calleja, Jose Luis ; Jansen, Christian ; Robic, Marie Angèle ; Conejo, Irene ; Catalina, Maria Vega ; Rudler, Marika ; Alvarado, Edilmar ; Perez-Campuzano, Valeria ; Guardascione, Maria Anna ; Fischer, Petra ; International Variceal Bleeding Observational Study Group and Baveno Cooperation. / Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis. I: Journal of Hepatology. 2021 ; Bind 75, Nr. 2. s. 342-350.

@article{4ca0a059672944d9a0ba49b1489ab057,

title = "Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis",

abstract = "Background & Aims: Antibiotic prophylaxis reduces the risk of infection and mortality in patients with cirrhosis and acute variceal bleeding (AVB). This study examines the incidence of, and risk factors for, bacterial infections during hospitalization in patients with AVB on antibiotic prophylaxis. Methods: A post hoc analysis was performed using the database of an international, multicenter, observational study designed to examine the role of pre-emptive transjugular intrahepatic portosystemic shunts in patients with cirrhosis and AVB. Data were collected on patients with cirrhosis hospitalized for AVB (n = 2,138) from a prospective cohort (October 2013-May 2015) at 34 referral centers, and a retrospective cohort (October 2011-September 2013) at 19 of these centers. The primary outcome was incidence of bacterial infection during hospitalization. Results: A total of 1,656 patients out of 1,770 (93.6%) received antibiotic prophylaxis; third-generation cephalosporins (76.2%) and quinolones (19.0%) were used most frequently. Of the patients on antibiotic prophylaxis, 320 patients developed bacterial infection during hospitalization. Respiratory infection accounted for 43.6% of infections and for 49.7% of infected patients, and occurred early after admission (median 3 days, IQR 1-6). On multivariate analysis, respiratory infection was independently associated with Child-Pugh C (odds ratio [OR] 3.1; 95% CI 1.4-6.7), grade III-IV encephalopathy (OR 2.8; 95% CI 1.8-4.4), orotracheal intubation for endoscopy (OR 2.6; 95% CI 1.8-3.8), nasogastric tube placement (OR 1.7; 95% CI 1.2-2.4) or esophageal balloon tamponade (OR 2.4; 95% CI 1.2-4.9). Conclusion: Bacterial infections develop in almost one-fifth of patients with AVB despite antibiotic prophylaxis. Respiratory infection is the most frequent, is an early event after admission, and is associated with advanced liver failure, severe hepatic encephalopathy and use of nasogastric tube, orotracheal intubation for endoscopy or esophageal balloon tamponade. Lay summary: Bacterial infections develop during hospitalization in close to 20% of patients with acute variceal bleeding despite antibiotic prophylaxis. Respiratory bacterial infections are the most frequent and occur early after admission. Respiratory infection is associated with advanced liver disease, severe hepatic encephalopathy and a need for a nasogastric tube, orotracheal intubation for endoscopy or esophageal balloon tamponade.",

keywords = "Acute variceal bleeding, Antibiotic prophylaxis, Bacterial infection, Cirrhosis, Respiratory infection",

author = "Javier Mart{\'i}nez and Virginia Hern{\'a}ndez-Gea and Enrique Rodr{\'i}guez-de-Santiago and Luis T{\'e}llez and Bogdan Procopet and {\'A}lvaro Gir{\'a}ldez and Lucio Amitrano and Candid Villanueva and Dominique Thabut and Luis Iba{\~n}ez-Samaniego and Gilberto Silva-Junior and Joan Genesc{\`a} and Christophe Bureau and Jonel Trebicka and Rafael Ba{\~n}ares and Aleksander Krag and Elba Llop and Wim Laleman and Palazon, {Jose Mar{\'i}a} and Jose Castellote and Susana Rodrigues and Gluud, {Lise L.} and Carlos Noronha-Ferreira and Nuria Ca{\~n}ete and Manuel Rodr{\'i}guez and Arnulf Ferlitsch and Remy Schwarzer and Mundi, {Jose Luis} and Henning Gronbaek and Manuel Hern{\'a}ndez-Guerra and Romano Sassatelli and Alessandra Dell'Era and Marco Senzolo and Abraldes, {Juan G.} and Manuel Romero-Gomez and Alexander Zipprich and Meritxell Casas and Helena Masnou and Massimo Primignani and Frederik Nevens and Calleja, {Jose Luis} and Christian Jansen and Robic, {Marie Ang{\`e}le} and Irene Conejo and Catalina, {Maria Vega} and Marika Rudler and Edilmar Alvarado and Valeria Perez-Campuzano and Guardascione, {Maria Anna} and Petra Fischer and {International Variceal Bleeding Observational Study Group and Baveno Cooperation}",

note = "Funding Information: Supported by grants from the Spanish Ministry of Science and Innovation ( SAF-2016-75767-R to JC.G-P, SAF 2017-86343-R awarded to A.A, Instituto de Salud Carlos III PIE 15/00027 to JC.G-P, PI17/00398 to V.H.G, PI18/01901 to R.B and PI20/01302 to A.A, and Commissioner for Universities and Research of the Generalitat de Catalunya ( AGAUR SGR 2017 awarded to JC.G-P). CIBEREHD is funded by the Instituto de Salud Carlos III with grants cofinanced by the European Development Regional Fund “A way to achieve Europe” (EDRF). Funding Information: Juan Carlos Garcia-Pagan has consultant fees for GORE, Shionogi and Cook grants from GORE and Novartis. {\'A}lvaro Gir{\'a}ldez has served as speaker for Gore. ",

year = "2021",

month = aug,

doi = "10.1016/j.jhep.2021.03.026",

language = "English",

volume = "75",

pages = "342--350",

journal = "Journal of Hepatology",

issn = "0168-8278",

publisher = "Elsevier",

number = "2",

}

Martínez, J, Hernández-Gea, V, Rodríguez-de-Santiago, E, Téllez, L, Procopet, B, Giráldez, Á, Amitrano, L, Villanueva, C, Thabut, D, Ibañez-Samaniego, L, Silva-Junior, G, Genescà, J, Bureau, C, Trebicka, J, Bañares, R, Krag, A, Llop, E, Laleman, W, Palazon, JM, Castellote, J, Rodrigues, S, Gluud, LL, Noronha-Ferreira, C, Cañete, N, Rodríguez, M, Ferlitsch, A, Schwarzer, R, Mundi, JL, Gronbaek, H, Hernández-Guerra, M, Sassatelli, R, Dell'Era, A, Senzolo, M, Abraldes, JG, Romero-Gomez, M, Zipprich, A, Casas, M, Masnou, H, Primignani, M, Nevens, F, Calleja, JL, Jansen, C, Robic, MA, Conejo, I, Catalina, MV, Rudler, M, Alvarado, E, Perez-Campuzano, V, Guardascione, MA, Fischer, P & International Variceal Bleeding Observational Study Group and Baveno Cooperation 2021, 'Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis', Journal of Hepatology, bind 75, nr. 2, s. 342-350. https://doi.org/10.1016/j.jhep.2021.03.026

Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis. / Martínez, Javier; Hernández-Gea, Virginia; Rodríguez-de-Santiago, Enrique; Téllez, Luis; Procopet, Bogdan; Giráldez, Álvaro; Amitrano, Lucio; Villanueva, Candid; Thabut, Dominique; Ibañez-Samaniego, Luis; Silva-Junior, Gilberto; Genescà, Joan; Bureau, Christophe; Trebicka, Jonel; Bañares, Rafael; Krag, Aleksander; Llop, Elba; Laleman, Wim; Palazon, Jose María; Castellote, Jose; Rodrigues, Susana; Gluud, Lise L.; Noronha-Ferreira, Carlos; Cañete, Nuria; Rodríguez, Manuel; Ferlitsch, Arnulf; Schwarzer, Remy; Mundi, Jose Luis; Gronbaek, Henning; Hernández-Guerra, Manuel; Sassatelli, Romano; Dell'Era, Alessandra; Senzolo, Marco; Abraldes, Juan G.; Romero-Gomez, Manuel; Zipprich, Alexander; Casas, Meritxell; Masnou, Helena; Primignani, Massimo; Nevens, Frederik; Calleja, Jose Luis; Jansen, Christian; Robic, Marie Angèle; Conejo, Irene; Catalina, Maria Vega; Rudler, Marika; Alvarado, Edilmar; Perez-Campuzano, Valeria; Guardascione, Maria Anna; Fischer, Petra; International Variceal Bleeding Observational Study Group and Baveno Cooperation.

I: Journal of Hepatology, Bind 75, Nr. 2, 08.2021, s. 342-350.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis

AU - Martínez, Javier

AU - Hernández-Gea, Virginia

AU - Rodríguez-de-Santiago, Enrique

AU - Téllez, Luis

AU - Procopet, Bogdan

AU - Giráldez, Álvaro

AU - Amitrano, Lucio

AU - Villanueva, Candid

AU - Thabut, Dominique

AU - Ibañez-Samaniego, Luis

AU - Silva-Junior, Gilberto

AU - Genescà, Joan

AU - Bureau, Christophe

AU - Trebicka, Jonel

AU - Bañares, Rafael

AU - Krag, Aleksander

AU - Llop, Elba

AU - Laleman, Wim

AU - Palazon, Jose María

AU - Castellote, Jose

AU - Rodrigues, Susana

AU - Gluud, Lise L.

AU - Noronha-Ferreira, Carlos

AU - Cañete, Nuria

AU - Rodríguez, Manuel

AU - Ferlitsch, Arnulf

AU - Schwarzer, Remy

AU - Mundi, Jose Luis

AU - Gronbaek, Henning

AU - Hernández-Guerra, Manuel

AU - Sassatelli, Romano

AU - Dell'Era, Alessandra

AU - Senzolo, Marco

AU - Abraldes, Juan G.

AU - Romero-Gomez, Manuel

AU - Zipprich, Alexander

AU - Casas, Meritxell

AU - Masnou, Helena

AU - Primignani, Massimo

AU - Nevens, Frederik

AU - Calleja, Jose Luis

AU - Jansen, Christian

AU - Robic, Marie Angèle

AU - Conejo, Irene

AU - Catalina, Maria Vega

AU - Rudler, Marika

AU - Alvarado, Edilmar

AU - Perez-Campuzano, Valeria

AU - Guardascione, Maria Anna

AU - Fischer, Petra

AU - International Variceal Bleeding Observational Study Group and Baveno Cooperation

N1 - Funding Information: Supported by grants from the Spanish Ministry of Science and Innovation ( SAF-2016-75767-R to JC.G-P, SAF 2017-86343-R awarded to A.A, Instituto de Salud Carlos III PIE 15/00027 to JC.G-P, PI17/00398 to V.H.G, PI18/01901 to R.B and PI20/01302 to A.A, and Commissioner for Universities and Research of the Generalitat de Catalunya ( AGAUR SGR 2017 awarded to JC.G-P). CIBEREHD is funded by the Instituto de Salud Carlos III with grants cofinanced by the European Development Regional Fund “A way to achieve Europe” (EDRF). Funding Information: Juan Carlos Garcia-Pagan has consultant fees for GORE, Shionogi and Cook grants from GORE and Novartis. Álvaro Giráldez has served as speaker for Gore.

PY - 2021/8

Y1 - 2021/8

N2 - Background & Aims: Antibiotic prophylaxis reduces the risk of infection and mortality in patients with cirrhosis and acute variceal bleeding (AVB). This study examines the incidence of, and risk factors for, bacterial infections during hospitalization in patients with AVB on antibiotic prophylaxis. Methods: A post hoc analysis was performed using the database of an international, multicenter, observational study designed to examine the role of pre-emptive transjugular intrahepatic portosystemic shunts in patients with cirrhosis and AVB. Data were collected on patients with cirrhosis hospitalized for AVB (n = 2,138) from a prospective cohort (October 2013-May 2015) at 34 referral centers, and a retrospective cohort (October 2011-September 2013) at 19 of these centers. The primary outcome was incidence of bacterial infection during hospitalization. Results: A total of 1,656 patients out of 1,770 (93.6%) received antibiotic prophylaxis; third-generation cephalosporins (76.2%) and quinolones (19.0%) were used most frequently. Of the patients on antibiotic prophylaxis, 320 patients developed bacterial infection during hospitalization. Respiratory infection accounted for 43.6% of infections and for 49.7% of infected patients, and occurred early after admission (median 3 days, IQR 1-6). On multivariate analysis, respiratory infection was independently associated with Child-Pugh C (odds ratio [OR] 3.1; 95% CI 1.4-6.7), grade III-IV encephalopathy (OR 2.8; 95% CI 1.8-4.4), orotracheal intubation for endoscopy (OR 2.6; 95% CI 1.8-3.8), nasogastric tube placement (OR 1.7; 95% CI 1.2-2.4) or esophageal balloon tamponade (OR 2.4; 95% CI 1.2-4.9). Conclusion: Bacterial infections develop in almost one-fifth of patients with AVB despite antibiotic prophylaxis. Respiratory infection is the most frequent, is an early event after admission, and is associated with advanced liver failure, severe hepatic encephalopathy and use of nasogastric tube, orotracheal intubation for endoscopy or esophageal balloon tamponade. Lay summary: Bacterial infections develop during hospitalization in close to 20% of patients with acute variceal bleeding despite antibiotic prophylaxis. Respiratory bacterial infections are the most frequent and occur early after admission. Respiratory infection is associated with advanced liver disease, severe hepatic encephalopathy and a need for a nasogastric tube, orotracheal intubation for endoscopy or esophageal balloon tamponade.

AB - Background & Aims: Antibiotic prophylaxis reduces the risk of infection and mortality in patients with cirrhosis and acute variceal bleeding (AVB). This study examines the incidence of, and risk factors for, bacterial infections during hospitalization in patients with AVB on antibiotic prophylaxis. Methods: A post hoc analysis was performed using the database of an international, multicenter, observational study designed to examine the role of pre-emptive transjugular intrahepatic portosystemic shunts in patients with cirrhosis and AVB. Data were collected on patients with cirrhosis hospitalized for AVB (n = 2,138) from a prospective cohort (October 2013-May 2015) at 34 referral centers, and a retrospective cohort (October 2011-September 2013) at 19 of these centers. The primary outcome was incidence of bacterial infection during hospitalization. Results: A total of 1,656 patients out of 1,770 (93.6%) received antibiotic prophylaxis; third-generation cephalosporins (76.2%) and quinolones (19.0%) were used most frequently. Of the patients on antibiotic prophylaxis, 320 patients developed bacterial infection during hospitalization. Respiratory infection accounted for 43.6% of infections and for 49.7% of infected patients, and occurred early after admission (median 3 days, IQR 1-6). On multivariate analysis, respiratory infection was independently associated with Child-Pugh C (odds ratio [OR] 3.1; 95% CI 1.4-6.7), grade III-IV encephalopathy (OR 2.8; 95% CI 1.8-4.4), orotracheal intubation for endoscopy (OR 2.6; 95% CI 1.8-3.8), nasogastric tube placement (OR 1.7; 95% CI 1.2-2.4) or esophageal balloon tamponade (OR 2.4; 95% CI 1.2-4.9). Conclusion: Bacterial infections develop in almost one-fifth of patients with AVB despite antibiotic prophylaxis. Respiratory infection is the most frequent, is an early event after admission, and is associated with advanced liver failure, severe hepatic encephalopathy and use of nasogastric tube, orotracheal intubation for endoscopy or esophageal balloon tamponade. Lay summary: Bacterial infections develop during hospitalization in close to 20% of patients with acute variceal bleeding despite antibiotic prophylaxis. Respiratory bacterial infections are the most frequent and occur early after admission. Respiratory infection is associated with advanced liver disease, severe hepatic encephalopathy and a need for a nasogastric tube, orotracheal intubation for endoscopy or esophageal balloon tamponade.

KW - Acute variceal bleeding

KW - Antibiotic prophylaxis

KW - Bacterial infection

KW - Cirrhosis

KW - Respiratory infection

U2 - 10.1016/j.jhep.2021.03.026

DO - 10.1016/j.jhep.2021.03.026

M3 - Journal article

C2 - 33845059

AN - SCOPUS:85107884249

VL - 75

SP - 342

EP - 350

JO - Journal of Hepatology

JF - Journal of Hepatology

SN - 0168-8278

IS - 2

ER -

Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis

Abstrakt

Bibliografisk note

Dokumenter og links

Fingeraftryk

Citationsformater