The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study - PubMed (original) (raw)

Multicenter Study

doi: 10.1111/liv.13195. Epub 2016 Jul 22.

Mauro Borzio 2, Claudia Pedicino 2, Rosa Simonetti 3, Angelo Rossini 4, Sergio Boccia 5, Irene Cacciola 6, Andrew K Burroughs 7, Matteo A Manini 8, Vincenzo La Mura 1, Paolo Angeli 9, Mauro Bernardi 10, Daniela Dalla Gasperina 11, Elena Dionigi 2, Clara Dibenedetto 2, Milena Arghittu 2; AISF Investigators

Collaborators, Affiliations

Multicenter Study

The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study

Francesco Salerno et al. Liver Int. 2017 Jan.

Abstract

Background & aims: Bacterial strains resistant to antibiotics are a serious clinical challenge. We assessed the antibiotic susceptibility of bacteria isolated from infections in patients with cirrhosis by a multicentre investigation.

Results: Three hundred and thirteen culture-positive infections (173 community acquired [CA] and 140 hospital acquired [HA]) were identified in 308 patients. Urinary tract infections, spontaneous bacterial peritonitis and bacteremias were the most frequent. Quinolone-resistant Gram-negative isolates were 48%, 44% were extended-spectrum beta-lactamase producers and 9% carbapenem resistant. In 83/313 culture-positive infections (27%), multidrug-resistant agents (MDRA) were isolated. This prevalence did not differ between CA and HA infections. MDRA were identified in 17 of 37 patients on quinolone prophylaxis, and in 46 of 166 not on prophylaxis (45% vs 27%; P<.03). In 287 cases an empiric antibiotic therapy was undertaken, in 37 (12.9%) this therapy failed. The in-hospital mortality rate of this subset of patients was significantly higher compared to patients who received an effective broad(er)-spectrum therapy (P=.038). During a 3-month follow-up, 56/203 culture-positive patients (27.6%) died, 24/63 who have had MDRA-related infections (38%) and 32/140 who have had antibiotic-susceptible infections (22.8%) (P=.025). Multivariate analysis disclosed MDRA infection, age, hepatocellular carcinoma, bilirubin, international normalized ratio and the occurrence of portal hypertension-related complications independent predictors of death.

Conclusions: Infection by MDRA is frequent in patients with cirrhosis and the prognosis is severe, especially in patients unresponsive to empiric antibiotic therapy.

Keywords: bacterial resistance; cirrhosis; portal hypertension; survival.

© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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