Quality statement 5: Prophylactic intravenous antibiotics for upper gastrointestinal bleeding

Quality statement

Young people and adults with cirrhosis and upper gastrointestinal bleeding are given prophylactic intravenous antibiotics at presentation.

Rationale

People with cirrhosis and upper gastrointestinal bleeding are prone to have bacterial infections during or soon after a bleeding episode. Those who develop bacterial infections have a higher risk of death and early rebleeding. Giving prophylactic intravenous antibiotics at presentation reduces bacterial infections. Giving antibiotics intravenously also overcomes the difficulties of oral administration in people with haematemesis and critical illness.

Quality measures

Structure

Evidence of local arrangements to ensure that young people and adults with cirrhosis and upper gastrointestinal bleeding are given prophylactic intravenous antibiotics at presentation.

Data source: Local data collection, for example, service protocol.

Process

Proportion of presentations of young people and adults with cirrhosis and upper gastrointestinal bleeding in which the person receives prophylactic intravenous antibiotics at presentation.

Numerator – the number in the denominator in which the person receives prophylactic intravenous antibiotics at presentation.

Denominator – the number of presentations of young people and adults with cirrhosis and upper gastrointestinal bleeding.

Data source: Local data collection, for example, audit of patient health records.

Outcome

a) Rate of bacterial infection in young people and adults with cirrhosis and upper gastrointestinal bleeding.

Data source: Local data collection, for example, audit of patient health records.

b) Length of hospital stay for young people and adults with cirrhosis and upper gastrointestinal bleeding.

Data source: Local data collection, for example, audit of patient health records.

c) Hospital re-admission rate for young people and adults with cirrhosis and upper gastrointestinal bleeding.

Data source: Local data collection, for example, audit of patient health records.

d) Mortality rate in young people and adults with cirrhosis and upper gastrointestinal bleeding.

Data source: Local data collection, for example, audit of patient health records.

What the quality statement means for different audiences

Service providers (such as hospitals, including emergency departments and specialist liver centres) have processes in place to ensure that young people and adults with cirrhosis and upper gastrointestinal bleeding are given prophylactic intravenous antibiotics at presentation. Providers should ensure that the choice of antibiotics is determined by local microbiological practices and that intravenous antibiotics are reviewed in line with NICE's guideline on antimicrobial stewardship.

Healthcare professionals (such as emergency consultants, gastroenterologists and hepatologists) give prophylactic intravenous antibiotics to young people and adults with cirrhosis and upper gastrointestinal bleeding at presentation. Healthcare professionals ensure that the choice of antibiotics is determined by local microbiological practices and that intravenous antibiotics are reviewed in line with NICE's guideline on antimicrobial stewardship.

Commissioners (such as clinical commissioning groups) commission services that give prophylactic intravenous antibiotics to young people and adults with cirrhosis and upper gastrointestinal bleeding at presentation.

Young people and adults with cirrhosis who are vomiting blood or passing blood in their stools should be given antibiotics through a drip to stop them getting an infection.

Source guidance

Definitions of terms used in this quality statement

Young people and adults

Young people are aged 16 and 17. Adults are aged over 18.

[NICE's guideline on non-alcoholic fatty liver disease]