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- Title
The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study.
- Authors
Salerno, Francesco; Borzio, Mauro; Pedicino, Claudia; Simonetti, Rosa; Rossini, Angelo; Boccia, Sergio; Cacciola, Irene; Burroughs, Andrew K.; Manini, Matteo A.; La Mura, Vincenzo; Angeli, Paolo; Bernardi, Mauro; Dalla Gasperina, Daniela; Dionigi, Elena; Dibenedetto, Clara; Arghittu, Milena; Francavilla, Antonio; Trevisani, Franco; Salmi, Andrea; Fatuzzo, Filippo
- 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.
- Subjects
MULTIDRUG resistance in bacteria; TREATMENT of cirrhosis of the liver; CIRRHOSIS of the liver; MULTI-centre shell model; PERITONITIS; BETA-lactamase inhibitors; PATIENTS; THERAPEUTICS
- Publication
Liver International, 2017, Vol 37, Issue 1, p71
- ISSN
1478-3223
- Publication type
Article
- DOI
10.1111/liv.13195