The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study

Francesco Salerno, Mauro Borzio, Claudia Pedicino, Rosa Simonetti, Angelo Rossini, Sergio Boccia, Irene Cacciola, Andrew K. Burroughs, Matteo A. Manini, Vincenzo La Mura, Paolo Angeli, Mauro Bernardi, Daniela Dalla Gasperina, Elena Dionigi, Clara Dibenedetto, Milena Arghittu

Research output: Contribution to journalArticle

31 Citations (Scopus)

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.

Original languageEnglish
JournalLiver International
DOIs
Publication statusAccepted/In press - 2016

Fingerprint

Proxy
Multicenter Studies
Fibrosis
Prospective Studies
Infection
Anti-Bacterial Agents
Quinolones
Community-Acquired Infections
Carbapenems
International Normalized Ratio
Community Hospital
Portal Hypertension
Therapeutics
beta-Lactamases
Cross Infection
Bacteremia
Hospital Mortality
Peritonitis
Bilirubin
Urinary Tract Infections

Keywords

  • Bacterial resistance
  • Cirrhosis
  • Portal hypertension
  • Survival

ASJC Scopus subject areas

  • Hepatology

Cite this

Salerno, F., Borzio, M., Pedicino, C., Simonetti, R., Rossini, A., Boccia, S., ... Arghittu, M. (Accepted/In press). The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study. Liver International. https://doi.org/10.1111/liv.13195

The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study. / 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.

In: Liver International, 2016.

Research output: Contribution to journalArticle

Salerno, F, Borzio, M, Pedicino, C, Simonetti, R, Rossini, A, Boccia, S, Cacciola, I, Burroughs, AK, Manini, MA, La Mura, V, Angeli, P, Bernardi, M, Dalla Gasperina, D, Dionigi, E, Dibenedetto, C & Arghittu, M 2016, 'The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study', Liver International. https://doi.org/10.1111/liv.13195
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. / The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study. In: Liver International. 2016.
@article{0f5b3dce27a44dee988929cf2473e8ef,
title = "The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study",
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.",
keywords = "Bacterial resistance, Cirrhosis, Portal hypertension, Survival",
author = "Francesco Salerno and Mauro Borzio and Claudia Pedicino and Rosa Simonetti and Angelo Rossini and Sergio Boccia and Irene Cacciola and Burroughs, {Andrew K.} and Manini, {Matteo A.} and {La Mura}, Vincenzo and Paolo Angeli and Mauro Bernardi and {Dalla Gasperina}, Daniela and Elena Dionigi and Clara Dibenedetto and Milena Arghittu",
year = "2016",
doi = "10.1111/liv.13195",
language = "English",
journal = "Liver International",
issn = "1478-3223",
publisher = "Wiley-Blackwell Publishing Ltd",

}

TY - JOUR

T1 - The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study

AU - Salerno, Francesco

AU - Borzio, Mauro

AU - Pedicino, Claudia

AU - Simonetti, Rosa

AU - Rossini, Angelo

AU - Boccia, Sergio

AU - Cacciola, Irene

AU - Burroughs, Andrew K.

AU - Manini, Matteo A.

AU - La Mura, Vincenzo

AU - Angeli, Paolo

AU - Bernardi, Mauro

AU - Dalla Gasperina, Daniela

AU - Dionigi, Elena

AU - Dibenedetto, Clara

AU - Arghittu, Milena

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

KW - Bacterial resistance

KW - Cirrhosis

KW - Portal hypertension

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=84994710591&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994710591&partnerID=8YFLogxK

U2 - 10.1111/liv.13195

DO - 10.1111/liv.13195

M3 - Article

AN - SCOPUS:84994710591

JO - Liver International

JF - Liver International

SN - 1478-3223

ER -