Philip G Ferstl1,2, Natalie Filmann3, Christian Brandt2,4, Stefan Zeuzem1,2, Michael Hogardt2,4, Volkhard A J Kempf2,4, Mona Müller1, Oliver Waidmann1,2, Claudia Reinheimer2,4. 1. Department for Internal Medicine I/Gastroenterology and Hepatology, University Hospital Frankfurt, Frankfurt am Main, Germany. 2. University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany. 3. Institute of Biostatistics and Mathematical Modeling, University Hospital Frankfurt, Frankfurt am Main, Germany. 4. Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.
Abstract
BACKGROUND & AIMS: Infections with multidrug-resistant gram-negative bacteria are significantly impairing the prognosis of patients with liver disease. In particular, carbapenem resistance further narrows therapeutic options. This study investigates the impact of carbapenem-resistant gram-negative bacteria on the outcome of patients with liver disease and cirrhosis. METHODS: Between January 2011 and July 2015, 132 patients treated at the tertiary liver transplant centre at University Hospital Frankfurt, Germany, were tested positive for carbapenem-resistant gram-negative bacteria and retrospectively analysed in this study. Risk factors for fatal outcome were evaluated using multivariate regression analysis. Competing-risk analysis was performed on patients tested positive for Enterobacteriaceae or non-fermenting species, for example, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia. Subgroup analysis of cirrhotic patients was performed on a matched cohort of cirrhotic patients, comparable model for end-stage liver disease and tested negative for carbapenem-resistant gram-negative bacteria. RESULTS: 97 (73.5%) and 35 (26.5%) patients were infected or colonised with carbapenem-resistant gram-negative bacteria respectively. Within the observation period, 61/132 (46.2%) patients died, with sepsis being the leading cause (38/61, 62.3%). Decompensated liver disease, sepsis and admission to intensive care unit were independent risk factors for fatal outcome. Lethal sepsis in patients positive for non-fermenting bacteria was significantly more frequent than in those positive for Enterobacteriaceae, independently from liver function. Subgroup analysis of cirrhotic patients showed that sepsis (54.9% vs 13%) and lethal sepsis were significantly more frequent after detection of carbapenem-resistant gram-negative bacteria, independently from localisation of pathogen detection. CONCLUSIONS: Patients with advanced liver disease are prone to fatal infections caused by carbapenem-resistant gram-negative bacteria.
BACKGROUND & AIMS: Infections with multidrug-resistant gram-negative bacteria are significantly impairing the prognosis of patients with liver disease. In particular, carbapenem resistance further narrows therapeutic options. This study investigates the impact of carbapenem-resistant gram-negative bacteria on the outcome of patients with liver disease and cirrhosis. METHODS: Between January 2011 and July 2015, 132 patients treated at the tertiary liver transplant centre at University Hospital Frankfurt, Germany, were tested positive for carbapenem-resistant gram-negative bacteria and retrospectively analysed in this study. Risk factors for fatal outcome were evaluated using multivariate regression analysis. Competing-risk analysis was performed on patients tested positive for Enterobacteriaceae or non-fermenting species, for example, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia. Subgroup analysis of cirrhotic patients was performed on a matched cohort of cirrhotic patients, comparable model for end-stage liver disease and tested negative for carbapenem-resistant gram-negative bacteria. RESULTS: 97 (73.5%) and 35 (26.5%) patients were infected or colonised with carbapenem-resistant gram-negative bacteria respectively. Within the observation period, 61/132 (46.2%) patients died, with sepsis being the leading cause (38/61, 62.3%). Decompensated liver disease, sepsis and admission to intensive care unit were independent risk factors for fatal outcome. Lethal sepsis in patients positive for non-fermenting bacteria was significantly more frequent than in those positive for Enterobacteriaceae, independently from liver function. Subgroup analysis of cirrhotic patients showed that sepsis (54.9% vs 13%) and lethal sepsis were significantly more frequent after detection of carbapenem-resistant gram-negative bacteria, independently from localisation of pathogen detection. CONCLUSIONS:Patients with advanced liver disease are prone to fatal infections caused by carbapenem-resistant gram-negative bacteria.
Authors: Philip G Ferstl; Mona Müller; Natalie Filmann; Michael Hogardt; Volkhard Aj Kempf; Thomas A Wichelhaus; Christian M Lange; Johannes Vermehren; Stefan Zeuzem; Claudia Reinheimer; Oliver Waidmann Journal: Infect Drug Resist Date: 2018-11-02 Impact factor: 4.003
Authors: Philip G Ferstl; Natalie Filmann; Eva-Maria Heilgenthal; Andreas A Schnitzbauer; Wolf O Bechstein; Volkhard A J Kempf; David Villinger; Tilman G Schultze; Michael Hogardt; Christoph Stephan; Haitham Mutlak; Nina Weiler; Marcus M Mücke; Jonel Trebicka; Stefan Zeuzem; Oliver Waidmann; Martin-Walter Welker Journal: PLoS One Date: 2021-01-22 Impact factor: 3.240
Authors: Vera Himmelsbach; Mate Knabe; Phillip G Ferstl; Kai-Henrik Peiffer; Jan A Stratmann; Thomas A Wichelhaus; Michael Hogardt; Volkhard A J Kempf; Stefan Zeuzem; Oliver Waidmann; Fabian Finkelmeier; Olivier Ballo Journal: J Cancer Res Clin Oncol Date: 2021-07-20 Impact factor: 4.322