Francesco Salerno1, Mauro Borzio2, Claudia Pedicino2, Rosa Simonetti3, Angelo Rossini4, Sergio Boccia5, Irene Cacciola6, Andrew K Burroughs7, Matteo A Manini8, Vincenzo La Mura1, Paolo Angeli9, Mauro Bernardi10, Daniela Dalla Gasperina11, Elena Dionigi2, Clara Dibenedetto2, Milena Arghittu2. 1. Medicina Interna, IRCCS San Donato, Università degli studi di Milano, San Donato Milanese, Milano, Italy. 2. Unità di Gastroenterologia e Microbiologia, Ospedale Predabissi, Melegnano, Italy. 3. Unità di Medicina 2, Ospedali Riuniti, Villa Sofia Cervello, Palermo, Italy. 4. Unità di Epatologia, Dipartimento di Medicina, Azienda Ospedaliera Spedali Civili, Brescia, Italy. 5. Unità di Gastroenterologia, Azienda Universitaria Ospedaliera di Ferrara, Ferrara, Italy. 6. Unità di Epatologia Clinica e Biomolecolare, Policlinico Universitario, Messina, Italy. 7. Sheila Sherlock Liver Center, Royal Free Hospital, London, UK. 8. Gastroenterologia-1, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. 9. Medicina Clinica e Sperimentale, Policlinico Universitario, Padova, Italy. 10. Unità di Semeiotica Medica, Department of Clinical Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy. 11. Sezione di Malattie Infettive, Dipartimento di Medicina Clinica, Università dell'Insubria, Varese, Italy.
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.
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.
Authors: S Pouriki; G Vrioni; H Sambatakou; A Alexopoulou; L Vasilieva; I Mani; A Tsakris; S P Dourakis Journal: Eur J Clin Microbiol Infect Dis Date: 2017-09-30 Impact factor: 3.267
Authors: Marco Fiore; Alberto Enrico Maraolo; Ivan Gentile; Guglielmo Borgia; Sebastiano Leone; Pasquale Sansone; Maria Beatrice Passavanti; Caterina Aurilio; Maria Caterina Pace Journal: World J Gastroenterol Date: 2017-07-07 Impact factor: 5.742
Authors: Alberto Ferrarese; Alberto Zanetto; Chiara Becchetti; Salvatore Stefano Sciarrone; Sarah Shalaby; Giacomo Germani; Martina Gambato; Francesco Paolo Russo; Patrizia Burra; Marco Senzolo Journal: World J Hepatol Date: 2018-02-27