Multidrug-Resistant Bacteria and Disease Progression in Patients with End-Stage Liver Disease and after Liver Transplantation.
Adolescent
Adult
Aged
Anti-Bacterial Agents
/ therapeutic use
Bacteria
/ drug effects
Bacterial Infections
/ diagnosis
Disease Progression
Drug Resistance, Multiple, Bacterial
End Stage Liver Disease
/ diagnosis
Female
Humans
Liver Transplantation
/ adverse effects
Male
Middle Aged
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Waiting Lists
Young Adult
Journal
Journal of gastrointestinal and liver diseases : JGLD
ISSN: 1842-1121
Titre abrégé: J Gastrointestin Liver Dis
Pays: Romania
ID NLM: 101272825
Informations de publication
Date de publication:
01 Sep 2019
01 Sep 2019
Historique:
received:
21
06
2019
accepted:
13
07
2019
entrez:
14
9
2019
pubmed:
14
9
2019
medline:
16
4
2020
Statut:
epublish
Résumé
Multidrug-resistant (MDR) pathogens represent an emerging challenge in end-stage liver disease and in liver transplant recipients. We evaluated the impact of MDR bacteria upon clinical outcomes in patients with end-stage liver disease (n = 777) at the time of enrollment on the liver transplant (LTx) waiting list, after first LTx (n = 645), and after second LTx (n = 128). Colonization/infection with MDR bacteria was present in 72/777 patients on the waiting list, in 98/645 patients at first LTx, and in 46/128 patients at second LTx. While on the LTx waiting list, the time until first hydropic decompensation (p = 0.021), hepatic encephalopathy (p < 0.001) and hepatorenal syndrome (p < 0.001) was reduced in the presence of MDR bacteria, which remained an independent risk factor of poor survival in multivariate analysis (p < 0.001). Following first and second liver transplant, MDR bacteria were associated with an increased risk of infection-related deaths (first LTx: p < 0.001; second LTx: p = 0.037) and reduced actuarial survival (first LTx: p < 0.001; second LTx: p = 0.046). We showed that MDR pathogens are associated with poor outcomes before, after first and after recurrent LTx.
Sections du résumé
BACKGROUND
BACKGROUND
Multidrug-resistant (MDR) pathogens represent an emerging challenge in end-stage liver disease and in liver transplant recipients.
METHODS
METHODS
We evaluated the impact of MDR bacteria upon clinical outcomes in patients with end-stage liver disease (n = 777) at the time of enrollment on the liver transplant (LTx) waiting list, after first LTx (n = 645), and after second LTx (n = 128).
RESULTS
RESULTS
Colonization/infection with MDR bacteria was present in 72/777 patients on the waiting list, in 98/645 patients at first LTx, and in 46/128 patients at second LTx. While on the LTx waiting list, the time until first hydropic decompensation (p = 0.021), hepatic encephalopathy (p < 0.001) and hepatorenal syndrome (p < 0.001) was reduced in the presence of MDR bacteria, which remained an independent risk factor of poor survival in multivariate analysis (p < 0.001). Following first and second liver transplant, MDR bacteria were associated with an increased risk of infection-related deaths (first LTx: p < 0.001; second LTx: p = 0.037) and reduced actuarial survival (first LTx: p < 0.001; second LTx: p = 0.046).
CONCLUSIONS
CONCLUSIONS
We showed that MDR pathogens are associated with poor outcomes before, after first and after recurrent LTx.
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM