Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide.

Adult Aged Anti-Bacterial Agents / therapeutic use Bacterial Infections / epidemiology Cross-Sectional Studies Drug Resistance, Multiple, Bacterial Female Global Health Hospital Mortality Humans Liver Cirrhosis / epidemiology Liver Transplantation Male Middle Aged Mycoses / epidemiology Prevalence Prognosis Prospective Studies Risk Factors Time Factors

Global Resistance Sepsis Stewardship

Journal

Gastroenterology

ISSN: 1528-0012

Titre abrégé: Gastroenterology

Pays: United States

ID NLM: 0374630

Informations de publication

Date de publication:
Apr 2019

Historique:

received: 22 09 2018

revised: 30 11 2018

accepted: 07 12 2018

pubmed: 16 12 2018

medline: 6 5 2019

entrez: 16 12 2018

Statut: ppublish

Résumé

Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis. We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge. The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%-37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival. In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.

Sections du résumé

BACKGROUND & AIMS OBJECTIVE

METHODS METHODS

We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge.

RESULTS RESULTS

The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%-37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival.

CONCLUSIONS CONCLUSIONS

In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.

Identifiants

DOI: 10.1053/j.gastro.2018.12.005 PMID: 30552895

pubmed: 30552895

pii: S0016-5085(18)35402-7

doi: 10.1053/j.gastro.2018.12.005

pii:

doi:

Substances chimiques

Anti-Bacterial Agents 0

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

1368-1380.e10

Investigateurs

Michele Bartoletti (M)

Carlos Brodersen (C)

Tony Bruns (T)

Robert A de Man (RA)

Annette Dam Fialla (AD)

Carmine Gambino (C)

Vikas Gautam (V)

Marcos Girala (M)

Adria Juanola (A)

Jeong Han Kim (JH)

Tae Hun Kim (TH)

Pramod Kumar (P)

Barbara Lattanzi (B)

Tae Hee Lee (TH)

Cosmas A Rinaldi Lesmana (CA)

Richard Moreau (R)

Preetam Nath (P)

Gustavo Navarro (G)

Ji-Won Park (JW)

Gisela Pinero (G)

Nikolaos T Pyrsopoulos (NT)

Sophie Restellini (S)

Gustavo Romero (G)

Marco Sacco (M)

Tiago Sevá-Pereira (T)

Macarena Simón-Talero (M)

Do Seon Song (DS)

Ki Tae Suk (KT)

Hans Van Vlierberghe (H)

Sun Young Yim (SY)

Eileen Laurel Yoon (EL)

Giacomo Zaccherini (G)