A prospective multicentre study of the epidemiology and outcomes of bloodstream infection in cirrhotic patients

ESGBIS/BICHROME Study Group

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To describe the current epidemiology of bloodstream infection (BSI) in patients with cirrhosis; and to analyse predictors of 30-day mortality and risk factors for antibiotic resistance.

METHODS: Cirrhotic patients developing a BSI episode were prospectively included at 19 centres in five countries from September 2014 to December 2015. The discrimination of mortality risk scores for 30-day mortality were compared by area under the receiver operator risk and Cox regression models. Risk factors for multidrug-resistant organisms (MDRO) were assessed with a logistic regression model.

RESULTS: We enrolled 312 patients. Gram-negative bacteria, Gram-positive bacteria and Candida spp. were the cause of BSI episodes in 53%, 47% and 7% of cases, respectively. The 30-day mortality rate was 25% and was best predicted by the Sequential Organ Failure Assessment (SOFA) and Chronic Liver Failure-SOFA (CLIF-SOFA) score. In a Cox regression model, delayed (>24 hours) antibiotic treatment (hazard ratio (HR) 7.58; 95% confidence interval (CI) 3.29-18.67; p < 0.001), inadequate empirical therapy (HR 3.14; 95% CI 1.93-5.12; p < 0.001) and CLIF-SOFA score (HR 1.35; 95% CI 1.28-1.43; p < 0.001) were independently associated with 30-day mortality. Independent risk factors for MDRO (31% of BSIs) were previous antimicrobial exposure (odds ratio (OR) 2.91; 95% CI 1.73-4.88; p < 0.001) and previous invasive procedures (OR 2.51; 95% CI 1.48-4.24; p 0.001), whereas spontaneous bacterial peritonitis as BSI source was associated with a lower odds of MDRO (OR 0.30; 95% CI 0.12-0.73; p 0.008).

CONCLUSIONS: MDRO account for nearly one-third of BSI in cirrhotic patients, often resulting in delayed or inadequate empirical antimicrobial therapy and increased mortality rates. Our data suggest that improved prevention and treatment strategies for MDRO are urgently needed in the liver cirrhosis patients.

Original languageEnglish
Pages (from-to)546.e1-546.e8
JournalClinical Microbiology and Infection
Volume24
Issue number5
DOIs
Publication statusPublished - May 2018

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Multicenter Studies
Epidemiology
Prospective Studies
Confidence Intervals
Mortality
Infection
End Stage Liver Disease
Odds Ratio
Proportional Hazards Models
Logistic Models
Organ Dysfunction Scores
Gram-Positive Bacteria
Therapeutics
Microbial Drug Resistance
Peritonitis
Gram-Negative Bacteria
Candida
Liver Cirrhosis
Fibrosis
Anti-Bacterial Agents

Keywords

  • Aged
  • Comorbidity
  • Disease Management
  • Drug Resistance, Microbial
  • Female
  • Humans
  • Liver Cirrhosis/complications
  • Male
  • Middle Aged
  • Mortality
  • Patient Outcome Assessment
  • Population Surveillance
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Sepsis/drug therapy

Cite this

A prospective multicentre study of the epidemiology and outcomes of bloodstream infection in cirrhotic patients. / ESGBIS/BICHROME Study Group.

In: Clinical Microbiology and Infection, Vol. 24, No. 5, 05.2018, p. 546.e1-546.e8.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVES: To describe the current epidemiology of bloodstream infection (BSI) in patients with cirrhosis; and to analyse predictors of 30-day mortality and risk factors for antibiotic resistance.METHODS: Cirrhotic patients developing a BSI episode were prospectively included at 19 centres in five countries from September 2014 to December 2015. The discrimination of mortality risk scores for 30-day mortality were compared by area under the receiver operator risk and Cox regression models. Risk factors for multidrug-resistant organisms (MDRO) were assessed with a logistic regression model.RESULTS: We enrolled 312 patients. Gram-negative bacteria, Gram-positive bacteria and Candida spp. were the cause of BSI episodes in 53{\%}, 47{\%} and 7{\%} of cases, respectively. The 30-day mortality rate was 25{\%} and was best predicted by the Sequential Organ Failure Assessment (SOFA) and Chronic Liver Failure-SOFA (CLIF-SOFA) score. In a Cox regression model, delayed (>24 hours) antibiotic treatment (hazard ratio (HR) 7.58; 95{\%} confidence interval (CI) 3.29-18.67; p < 0.001), inadequate empirical therapy (HR 3.14; 95{\%} CI 1.93-5.12; p < 0.001) and CLIF-SOFA score (HR 1.35; 95{\%} CI 1.28-1.43; p < 0.001) were independently associated with 30-day mortality. Independent risk factors for MDRO (31{\%} of BSIs) were previous antimicrobial exposure (odds ratio (OR) 2.91; 95{\%} CI 1.73-4.88; p < 0.001) and previous invasive procedures (OR 2.51; 95{\%} CI 1.48-4.24; p 0.001), whereas spontaneous bacterial peritonitis as BSI source was associated with a lower odds of MDRO (OR 0.30; 95{\%} CI 0.12-0.73; p 0.008).CONCLUSIONS: MDRO account for nearly one-third of BSI in cirrhotic patients, often resulting in delayed or inadequate empirical antimicrobial therapy and increased mortality rates. Our data suggest that improved prevention and treatment strategies for MDRO are urgently needed in the liver cirrhosis patients.",
keywords = "Aged, Comorbidity, Disease Management, Drug Resistance, Microbial, Female, Humans, Liver Cirrhosis/complications, Male, Middle Aged, Mortality, Patient Outcome Assessment, Population Surveillance, Prognosis, Prospective Studies, Risk Factors, Sepsis/drug therapy",
author = "{ESGBIS/BICHROME Study Group} and M Bartoletti and M Giannella and R Lewis and P Caraceni and S Tedeschi and M Paul and C Schramm and T Bruns and M Merli and N Cobos-Trigueros and E Seminari and P Retamar and P Mu{\~n}oz and M Tumbarello and P Burra and {Torrani Cerenzia}, M and B Barsic and E Calbo and Maraolo, {A E} and N Petrosillo and Galan-Ladero, {M A} and G D'Offizi and {Bar Sinai}, N and J Rodr{\'i}guez-Ba{\~n}o and G Verucchi and M Bernardi and P Viale",
note = "Copyright {\circledC} 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.",
year = "2018",
month = "5",
doi = "10.1016/j.cmi.2017.08.001",
language = "English",
volume = "24",
pages = "546.e1--546.e8",
journal = "Clinical Microbiology and Infection",
issn = "1198-743X",
publisher = "Elsevier B.V.",
number = "5",

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TY - JOUR

T1 - A prospective multicentre study of the epidemiology and outcomes of bloodstream infection in cirrhotic patients

AU - ESGBIS/BICHROME Study Group

AU - Bartoletti, M

AU - Giannella, M

AU - Lewis, R

AU - Caraceni, P

AU - Tedeschi, S

AU - Paul, M

AU - Schramm, C

AU - Bruns, T

AU - Merli, M

AU - Cobos-Trigueros, N

AU - Seminari, E

AU - Retamar, P

AU - Muñoz, P

AU - Tumbarello, M

AU - Burra, P

AU - Torrani Cerenzia, M

AU - Barsic, B

AU - Calbo, E

AU - Maraolo, A E

AU - Petrosillo, N

AU - Galan-Ladero, M A

AU - D'Offizi, G

AU - Bar Sinai, N

AU - Rodríguez-Baño, J

AU - Verucchi, G

AU - Bernardi, M

AU - Viale, P

N1 - Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

PY - 2018/5

Y1 - 2018/5

N2 - OBJECTIVES: To describe the current epidemiology of bloodstream infection (BSI) in patients with cirrhosis; and to analyse predictors of 30-day mortality and risk factors for antibiotic resistance.METHODS: Cirrhotic patients developing a BSI episode were prospectively included at 19 centres in five countries from September 2014 to December 2015. The discrimination of mortality risk scores for 30-day mortality were compared by area under the receiver operator risk and Cox regression models. Risk factors for multidrug-resistant organisms (MDRO) were assessed with a logistic regression model.RESULTS: We enrolled 312 patients. Gram-negative bacteria, Gram-positive bacteria and Candida spp. were the cause of BSI episodes in 53%, 47% and 7% of cases, respectively. The 30-day mortality rate was 25% and was best predicted by the Sequential Organ Failure Assessment (SOFA) and Chronic Liver Failure-SOFA (CLIF-SOFA) score. In a Cox regression model, delayed (>24 hours) antibiotic treatment (hazard ratio (HR) 7.58; 95% confidence interval (CI) 3.29-18.67; p < 0.001), inadequate empirical therapy (HR 3.14; 95% CI 1.93-5.12; p < 0.001) and CLIF-SOFA score (HR 1.35; 95% CI 1.28-1.43; p < 0.001) were independently associated with 30-day mortality. Independent risk factors for MDRO (31% of BSIs) were previous antimicrobial exposure (odds ratio (OR) 2.91; 95% CI 1.73-4.88; p < 0.001) and previous invasive procedures (OR 2.51; 95% CI 1.48-4.24; p 0.001), whereas spontaneous bacterial peritonitis as BSI source was associated with a lower odds of MDRO (OR 0.30; 95% CI 0.12-0.73; p 0.008).CONCLUSIONS: MDRO account for nearly one-third of BSI in cirrhotic patients, often resulting in delayed or inadequate empirical antimicrobial therapy and increased mortality rates. Our data suggest that improved prevention and treatment strategies for MDRO are urgently needed in the liver cirrhosis patients.

AB - OBJECTIVES: To describe the current epidemiology of bloodstream infection (BSI) in patients with cirrhosis; and to analyse predictors of 30-day mortality and risk factors for antibiotic resistance.METHODS: Cirrhotic patients developing a BSI episode were prospectively included at 19 centres in five countries from September 2014 to December 2015. The discrimination of mortality risk scores for 30-day mortality were compared by area under the receiver operator risk and Cox regression models. Risk factors for multidrug-resistant organisms (MDRO) were assessed with a logistic regression model.RESULTS: We enrolled 312 patients. Gram-negative bacteria, Gram-positive bacteria and Candida spp. were the cause of BSI episodes in 53%, 47% and 7% of cases, respectively. The 30-day mortality rate was 25% and was best predicted by the Sequential Organ Failure Assessment (SOFA) and Chronic Liver Failure-SOFA (CLIF-SOFA) score. In a Cox regression model, delayed (>24 hours) antibiotic treatment (hazard ratio (HR) 7.58; 95% confidence interval (CI) 3.29-18.67; p < 0.001), inadequate empirical therapy (HR 3.14; 95% CI 1.93-5.12; p < 0.001) and CLIF-SOFA score (HR 1.35; 95% CI 1.28-1.43; p < 0.001) were independently associated with 30-day mortality. Independent risk factors for MDRO (31% of BSIs) were previous antimicrobial exposure (odds ratio (OR) 2.91; 95% CI 1.73-4.88; p < 0.001) and previous invasive procedures (OR 2.51; 95% CI 1.48-4.24; p 0.001), whereas spontaneous bacterial peritonitis as BSI source was associated with a lower odds of MDRO (OR 0.30; 95% CI 0.12-0.73; p 0.008).CONCLUSIONS: MDRO account for nearly one-third of BSI in cirrhotic patients, often resulting in delayed or inadequate empirical antimicrobial therapy and increased mortality rates. Our data suggest that improved prevention and treatment strategies for MDRO are urgently needed in the liver cirrhosis patients.

KW - Aged

KW - Comorbidity

KW - Disease Management

KW - Drug Resistance, Microbial

KW - Female

KW - Humans

KW - Liver Cirrhosis/complications

KW - Male

KW - Middle Aged

KW - Mortality

KW - Patient Outcome Assessment

KW - Population Surveillance

KW - Prognosis

KW - Prospective Studies

KW - Risk Factors

KW - Sepsis/drug therapy

U2 - 10.1016/j.cmi.2017.08.001

DO - 10.1016/j.cmi.2017.08.001

M3 - Article

VL - 24

SP - 546.e1-546.e8

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

SN - 1198-743X

IS - 5

ER -