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

M. Bartoletti, M. Giannella, R. Lewis, P. Caraceni, S. Tedeschi, M. Paul, C. Schramm, T. Bruns, M. Merli, N. Cobos-Trigueros, E. Seminari, P. Retamar, P. Muñoz, M. Tumbarello, P. Burra, M. Torrani Cerenzia, B. Barsic, E. Calbo, A.E. Maraolo, N. PetrosilloM.A. Galan-Ladero, G. D'Offizi, N. Bar Sinai, J. Rodríguez-Baño, G. Verucchi, M. Bernardi, P. Viale, C. Campoli, G. Siccardi, S. Ambretti, A. Stallmach, M. Venditti, C. Lucidi, S. Ludovisi, M. De Cueto, M.D. Navarro, E. Lopez Cortes, E. Bouza, M. Valerio, A. Eworo, R. Losito, M. Senzolo, E. Nadal, A. Ottobrelli, M. Varguvic, C. Badia, G. Borgia, I. Gentile, E. Boumis, A. Rianda

Research output: Contribution to journalArticlepeer-review


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. © 2017 European Society of Clinical Microbiology and Infectious Diseases
Original languageEnglish
Pages (from-to)546.e1-546.e8
JournalClinical Microbiology and Infection
Issue number5
Publication statusPublished - 2018


  • antiinfective agent, adult
  • all cause mortality
  • antibiotic therapy
  • Article
  • bacterial peritonitis
  • bloodstream infection
  • Candida
  • carbapenem-resistant Enterobacteriaceae
  • chronic liver failure
  • cohort analysis
  • Enterococcus faecium
  • extended spectrum beta lactamase producing Enterobacteriaceae
  • female
  • human
  • invasive procedure
  • liver cirrhosis
  • major clinical study
  • male
  • methicillin susceptible Staphylococcus aureus
  • middle aged
  • multidrug resistance
  • nonhuman
  • pathogenesis
  • priority journal
  • prospective study
  • risk factor
  • Sequential Organ Failure Assessment Score
  • Streptococcus pneumoniae
  • therapy delay
  • aged
  • antibiotic resistance
  • clinical trial
  • comorbidity
  • complication
  • disease management
  • health survey
  • mortality
  • multicenter study
  • outcome assessment
  • prognosis
  • sepsis, Aged
  • Comorbidity
  • Disease Management
  • Drug Resistance, Microbial
  • Female
  • Humans
  • Liver Cirrhosis
  • Male
  • Middle Aged
  • Mortality
  • Patient Outcome Assessment
  • Population Surveillance
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Sepsis


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