Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe

JOURNAL OF HEPATOLOGY

卷:70

Article

Fernandez, Javier^1,2,3  Prado, Veronica¹  Trebicka, Jonel^2,4  Amoros, Alex²  Gustot, Thierry⁵  Wiest, Reiner⁶  Deulofeu, Carme²  Garcia, Elisabet²  Acevedo, Juan⁷  Fuhrmann, Valentin⁸  Durand, Francois⁹  Sanchez, Cristina²  Papp, Maria¹⁰  Caraceni, Paolo¹¹  Vargas, Victor^3,12  Banares, Rafael^3,13  Piano, Salvatore¹⁴  Janicko, Martin¹⁵  Albillos, Agustin¹⁶  Alessandria, Carlo¹⁷  Soriano, German^3,18  Welzel, Tania M.¹⁹  Laleman, Wim²⁰  Gerbes, Alexander²¹  De Gottardi, Andrea⁶  Merli, Manuela²²  Coenraad, Minneke²³  Saliba, Faouzi²⁴  Pavesi, Marco²  Jalan, Rajiv²⁵  Gines, Pere^1,3  Angeli, Paolo¹⁴  Arroyo, Vicente² 

[1] Univ Barcelona, Hosp Clin, Liver Unit, Liver ICU, Barcelona, Spain

[2] European Fdn Chron Liver Failure EF Clif, Barcelona, Spain

[3] ISCIII, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain

[4] Univ Bonn, Bonn, Germany

[5] Erasme Univ Hosp, Liver Transplant Unit, Brussels, Belgium

[6] Univ Bern, Dept Med & Surg, Inselspital, Bern, Switzerland

[7] Derriford Hosp, South West Liver Unit, Plymouth, Devon, England

[8] Univ Med Ctr Hamburg Eppendorf, Hamburg, Germany

[9] Hop Beaujon, Paris, France

[10] Univ Debrecen, Div Gastroenterol, Dept Internal Med, Fac Med, Debrecen, Hungary

[11] Univ Bologna, Bologna, Italy

[12] Hosp Valle De Hebron, Barcelona, Spain

[13] Hosp Gregorio Maranon, Madrid, Spain

[14] Univ Padua, Padua, Italy

[15] Pavol Jozef Safarik Univ, Kosice, Slovakia

[16] Hosp Univ Ramon & Cajal, Madrid, Spain

[17] San Giovanni Battista Hosp, Turin, Italy

[18] Hosp Santa Creu & Sant Pau, Barcelona, Spain

[19] Univ Hosp Frankfurt, Frankfurt, Germany

[20] Univ UZ Leuven, Leuven, Belgium

[21] Ludwig Maximilians Univ Munchen, Univ Hosp, Liver Ctr Munich, Dept Med 2, Munich, Germany

[22] Sapienza Univ Rome, Rome, Italy

[23] Leiden Univ, Med Ctr, Leiden, Netherlands

[24] Hop Paul Brousse, Ctr Hepatobiliare, Paris, France

[25] UCL, Sch Med, Div Med, ILDH, London, England

关键词: Epidemiology;    Prevalence;    Prognosis;    Antibiotic resistance;    Antibiotic strategies;   

DOI  :  10.1016/j.jhep.2018.10.027

来源: Elsevier

【 摘 要 】

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. (C) 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

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