M Bartoletti1, M Giannella2, R Lewis2, P Caraceni3, S Tedeschi2, M Paul4, C Schramm5, T Bruns6, M Merli7, N Cobos-Trigueros8, E Seminari9, P Retamar10, P Muñoz11, M Tumbarello12, P Burra13, M Torrani Cerenzia14, B Barsic15, E Calbo16, A E Maraolo17, N Petrosillo18, M A Galan-Ladero19, G D'Offizi20, N Bar Sinai4, J Rodríguez-Baño10, G Verucchi2, M Bernardi3, P Viale2. 1. Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, Bologna, Italy. Electronic address: michelele.bartoletti4@unibo.it. 2. Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, Bologna, Italy. 3. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 4. Unit of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel. 5. Department of Gastroenterology and Hepatology, University Clinic of Cologne, Cologne, Germany. 6. Department of Internal Medicine IV, Jena University Hospital, Friedrich Schiller University, Jena, Germany. 7. Division of Gastroenterology, Department of Clinical Medicine, 'Sapienza' University of Rome, Rome, Italy. 8. Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain. 9. Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 10. Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, Spain. 11. Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 12. Institute of Infectious Diseases, Policlinico Universitario Agostino Gemelli, Rome, Italy. 13. Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, Padova, Italy. 14. Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy. 15. Infectious Diseases, University Hospital for Infectious Diseases 'Dr. Fran Mihaljevic', Zagreb, Croatia. 16. Infectious Disease Unit, Service of Internal Medicine, Hospital Universitari Mútua de Terrassa, Plaça del Doctor Robert, Barcelona, Spain. 17. Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy. 18. 2nd Infectious Diseases Division, Rome, Italy. 19. Clinical Microbiology, Nuestra Senora del Prado Hospital, Madrid, Spain. 20. Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases 'L. Spallanzani', Rome, Italy.
Abstract
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.
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 cirrhosispatients.
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
Authors: Marie Schultalbers; Tammo L Tergast; Nicolas Simon; Abdul-Rahman Kabbani; Markus Kimmann; Christoph Höner Zu Siederdissen; Svetlana Gerbel; Michael P Manns; Markus Cornberg; Benjamin Maasoumy Journal: United European Gastroenterol J Date: 2020-03-13 Impact factor: 4.623