Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with ACLF across Europe

Fernández, Javier and Prado, Verónica and Trebica, Jonel and Amoros, Alex and Gustot, Thierry and Wiest, Reiner and Deulofeu, Carme and Garcia, Elisabet and Acevedo, Juan and Fuhrmann, Valentin and Durand, Francois and Sanchez, Cristina and Papp, Mária and Caraceni, Paolo and Vargas, Victor and Banares, Rafael and Piano, Salvatore and Janiczko, Martin and Agustin, Albillos and Alessandria, Carlo and Soriano, German and Welzel, Tania M. and Laleman, Wim and Gerbes, Alexander and De Gottardi, Andrea and Merli, Manuela and Coenraad, Minneke and Saliba, Faouzi and Pavesi, Marco and Jalan, Rajiv and Gines, Pere and Angeli, Paolo and Arroyo, Vincente (2018) Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with ACLF across Europe. Journal of Hepatology. ISSN 0168-8278 (In Press)

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BACKGROUND & AIMS: Antibiotic resistance has been increasingly reported in patients with decompensated cirrhosis in single-center studies. Prospective investigations reporting broad epidemiological data are scarce. We aimed to analyze epidemiological changes in bacterial infections in patients with decompensated cirrhosis. METHODS: This was a prospective evaluation of 2 series of patients hospitalized with decompensated cirrhosis. The Canonic series included 1,146 patients from Northern, Southern and Western Europe in 2011. Data on epidemiology, clinical characteristics of bacterial infections, microbiology and empirical antibiotic schedules were assessed. A second series of 883 patients from Eastern, Southern and Western Europe was investigated between 2017-2018. RESULTS: A total of 455 patients developed 520 infections (39.7%) in the first series, with spontaneous bacterial peritonitis, urinary tract infections and pneumonia the most frequent infections. Nosocomial episodes predominated in this series. Nearly half of the infections were culture-positive, of which 29.2% were caused by multidrug-resistant organisms (MDROs). MDR strains were more frequently isolated in Northern and Western Europe. Extended-spectrum beta-lactamase-producing Enterobacteriaceae were the most frequent MDROs isolated in this series, although prevalence and type differed markedly among countries and centers. Antibiotic resistance was associated with poor prognosis and failure of antibiotic strategies, based on third-generation cephalosporins or quinolones. Nosocomial infection (odds ratio [OR] 2.74; p < 0.001), intensive care unit admission (OR 2.09; p = 0.02), and recent hospitalization (OR 1.93; p = 0.04) were identified as independent predictors of MDR infection. The prevalence of MDROs in the second series (392 infections/284 patients) was 23%; 38% in culture-positive infections. A mild increase in the rate of carbapenem-resistant Enterobacteriaceae was observed in this series. CONCLUSIONS: MDR bacterial infections constitute a prevalent, growing and complex healthcare problem in patients with decompensated cirrhosis and acute-on-chronic liver failure across Europe, negatively impacting on prognosis. Strategies aimed at preventing the spread of antibiotic resistance in cirrhosis should be urgently evaluated. LAY SUMMARY: Infections caused by bacteria resistant to the main antibiotic families are prevalent in patients with cirrhosis. This study demonstrates that this healthcare problem is increasing and extends through all European regions. Infections caused by these difficult to treat bacteria resolve less frequently and often cause the death of the patient. The type of resistant bacteria varies markedly among different hospitals. Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. KEYWORDS: Antibiotic resistance; Antibiotic strategies; Epidemiology; Prevalence; Prognosis

Item Type: Article
Subjects: R Medicine / orvostudomány > R1 Medicine (General) / orvostudomány általában
R Medicine / orvostudomány > RC Internal medicine / belgyógyászat
Depositing User: Dr Mária/M Papp
Date Deposited: 28 Jan 2019 14:08
Last Modified: 28 Jan 2019 14:08

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