Tony Bruns1,2, Philipp A Reuken1,2, Sven Stengel2, Ludmila Gerber3, Beate Appenrodt4, Johannes H Schade2, Frank Lammert4, Stefan Zeuzem3, Andreas Stallmach1,2. 1. The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany. 2. Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany. 3. Department of Internal Medicine I, Frankfurt University Hospital, Frankfurt, Germany. 4. Department of Internal Medicine II, Saarland University Hospital, Homburg, Germany.
Abstract
BACKGROUND & AIMS: Circulating and peritoneal fragments of microbial DNA (bactDNA) are evidence for bacterial translocation in decompensated cirrhosis and may serve as a rational approach for antibiotic therapy when infection is suspected. METHODS: Prospective multicenter study to investigate whether identification of bactDNA from blood or ascitic fluid (AF) by multiplex polymerase chain reaction (PCR) is associated with increased 90-day mortality in 218 patients with cirrhosis and signs of infection. RESULTS: BactDNA in either compartment was detected in 134 (61%) patients, comprising 54 with bactDNA in blood and AF, 48 with AF bactDNA only, and 32 with blood bactDNA only. BactDNA was associated with spontaneous bacterial peritonitis and blood stream infections (SBP/BSI), acute-on-chronic liver failure (ACLF), encephalopathy and markers of inflammation. The prevalence of bactDNA in patients with proven SBP/BSI (36/49; 73%) was similar to that in patients with sterile ACLF (37/52; 71%). Actuarial 90-day survival was 56 ± 5% in the absence of bactDNA in both compartments and did not differ if bactDNA was detected in blood only (63 ± 9%), AF only (63 ± 7%), or in blood and AF (52 ± 7%). Predictors of 90-day mortality were SBP (HR = 3.10; 95% CI: 1.90-5.06), BSI (HR = 4.94; 95% CI: 2.71-9.02), and ACLF (HR = 2.20; 95% CI: 1.44-3.35). The detection of resistance genes in blood or AF in the absence of SBP/BSI (n = 11) was associated with poor 1-year survival (HR = 2.35; 95% CI: 1.03-5.35). CONCLUSIONS: BactDNA in sterile body fluids did not indicate increased mortality in cirrhotic patients with suspected infection. Using multiplex PCR for risk stratification cannot be recommended in these patients.
BACKGROUND & AIMS: Circulating and peritoneal fragments of microbial DNA (bactDNA) are evidence for bacterial translocation in decompensated cirrhosis and may serve as a rational approach for antibiotic therapy when infection is suspected. METHODS: Prospective multicenter study to investigate whether identification of bactDNA from blood or ascitic fluid (AF) by multiplex polymerase chain reaction (PCR) is associated with increased 90-day mortality in 218 patients with cirrhosis and signs of infection. RESULTS: BactDNA in either compartment was detected in 134 (61%) patients, comprising 54 with bactDNA in blood and AF, 48 with AF bactDNA only, and 32 with blood bactDNA only. BactDNA was associated with spontaneous bacterial peritonitis and blood stream infections (SBP/BSI), acute-on-chronic liver failure (ACLF), encephalopathy and markers of inflammation. The prevalence of bactDNA in patients with proven SBP/BSI (36/49; 73%) was similar to that in patients with sterile ACLF (37/52; 71%). Actuarial 90-day survival was 56 ± 5% in the absence of bactDNA in both compartments and did not differ if bactDNA was detected in blood only (63 ± 9%), AF only (63 ± 7%), or in blood and AF (52 ± 7%). Predictors of 90-day mortality were SBP (HR = 3.10; 95% CI: 1.90-5.06), BSI (HR = 4.94; 95% CI: 2.71-9.02), and ACLF (HR = 2.20; 95% CI: 1.44-3.35). The detection of resistance genes in blood or AF in the absence of SBP/BSI (n = 11) was associated with poor 1-year survival (HR = 2.35; 95% CI: 1.03-5.35). CONCLUSIONS: BactDNA in sterile body fluids did not indicate increased mortality in cirrhotic patients with suspected infection. Using multiplex PCR for risk stratification cannot be recommended in these patients.
Authors: Tony Bruns; Philipp A Reuken; Sven Stengel; Ludmila Gerber; Beate Appenrodt; Johannes H Schade; Frank Lammert; Stefan Zeuzem; Andreas Stallmach Journal: Dig Dis Sci Date: 2016-04-06 Impact factor: 3.199
Authors: Philipp Lutz; Felix Goeser; Dominik J Kaczmarek; Stefan Schlabe; Hans Dieter Nischalke; Jacob Nattermann; Achim Hoerauf; Christian P Strassburg; Ulrich Spengler Journal: Dig Dis Sci Date: 2017-06-09 Impact factor: 3.199
Authors: Paul Horn; Christian von Loeffelholz; Franziska Forkert; Sven Stengel; Philipp Reuken; René Aschenbach; Andreas Stallmach; Tony Bruns Journal: Sci Rep Date: 2018-06-18 Impact factor: 4.379
Authors: Nikhil Vergis; Stephen R Atkinson; Suzanne Knapp; James Maurice; Michael Allison; Andrew Austin; Ewan H Forrest; Steven Masson; Anne McCune; David Patch; Paul Richardson; Dermot Gleeson; Stephen D Ryder; Mark Wright; Mark R Thursz Journal: Gastroenterology Date: 2016-12-30 Impact factor: 22.682
Authors: Johanna Reißing; Philipp Lutz; Mick Frissen; Oluwatomi Ibidapo-Obe; Philipp A Reuken; Theresa H Wirtz; Sven Stengel; Stefanie Quickert; Michael Rooney; Karsten Große; Henning W Zimmermann; Christian Trautwein; Andreas Stallmach; Tony Bruns Journal: JHEP Rep Date: 2021-11-03
Authors: Oluwatomi Ibidapo-Obe; Sven Stengel; Nilay Köse-Vogel; Stefanie Quickert; Philipp A Reuken; Martin Busch; Michael Bauer; Andreas Stallmach; Tony Bruns Journal: Cell Mol Gastroenterol Hepatol Date: 2020-01-15