The multi-drug resistant organisms infections decrease during the antimicrobial stewardship era in cirrhotic patients: An Italian cohort study.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2023
2023
Historique:
received:
14
09
2022
accepted:
01
02
2023
entrez:
16
2
2023
pubmed:
17
2
2023
medline:
22
2
2023
Statut:
epublish
Résumé
Bacterial infections represent a major cause of morbidity and mortality in cirrhotic patients. Our aim was to assess the incidence of bacterial infections, in particular due to multidrug-resistant organisms (MDROs) before and after the introduction of the antimicrobial stewardship program, "Stewardship Antimicrobial in VErona" (SAVE). In addition, we also analysed the liver complications and the crude mortality during the whole follow up. We analysed 229 cirrhotic subjects without previous hospitalization for infections enrolled at the University Verona Hospital from 2017 to 2019 and followed up until December 2021 (mean follow-up 42.7 months). 101 infections were recorded and 31.7% were recurrent. The most frequent were sepsis (24.7%), pneumonia (19.8%), spontaneous bacterial peritonitis (17.8%). 14.9% of infections were sustained by MDROs. Liver complications occurred more frequently in infected patients, and in case of MDROs infections with a significantly higher MELD and Child-Pugh score. In Cox regression analysis, mortality was associated with age, diabetes and bacterial infections episodes (OR 3.30, CI 95%: (1.63-6.70). Despite an increase in total infections over the past three years, a decrease in the incidence rate in MDROs infections was documented concurrently with the introduction of SAVE (IRD 28.6; 95% CI: 4.6-52.5, p = 0.02). Our study confirms the burden of bacterial infections in cirrhotic patients, especially MDROs, and the strong interconnection with liver complications. The introduction of SAVE decreased MDROs infections. Cirrhotic patients require a closer clinical surveillance to identify colonized patients and avoid the horizontal spread of MDROs in this setting.
Sections du résumé
BACKGROUND AND PURPOSE
Bacterial infections represent a major cause of morbidity and mortality in cirrhotic patients. Our aim was to assess the incidence of bacterial infections, in particular due to multidrug-resistant organisms (MDROs) before and after the introduction of the antimicrobial stewardship program, "Stewardship Antimicrobial in VErona" (SAVE). In addition, we also analysed the liver complications and the crude mortality during the whole follow up.
METHODS
We analysed 229 cirrhotic subjects without previous hospitalization for infections enrolled at the University Verona Hospital from 2017 to 2019 and followed up until December 2021 (mean follow-up 42.7 months).
RESULTS
101 infections were recorded and 31.7% were recurrent. The most frequent were sepsis (24.7%), pneumonia (19.8%), spontaneous bacterial peritonitis (17.8%). 14.9% of infections were sustained by MDROs. Liver complications occurred more frequently in infected patients, and in case of MDROs infections with a significantly higher MELD and Child-Pugh score. In Cox regression analysis, mortality was associated with age, diabetes and bacterial infections episodes (OR 3.30, CI 95%: (1.63-6.70). Despite an increase in total infections over the past three years, a decrease in the incidence rate in MDROs infections was documented concurrently with the introduction of SAVE (IRD 28.6; 95% CI: 4.6-52.5, p = 0.02).
CONCLUSIONS
Our study confirms the burden of bacterial infections in cirrhotic patients, especially MDROs, and the strong interconnection with liver complications. The introduction of SAVE decreased MDROs infections. Cirrhotic patients require a closer clinical surveillance to identify colonized patients and avoid the horizontal spread of MDROs in this setting.
Identifiants
pubmed: 36795664
doi: 10.1371/journal.pone.0281813
pii: PONE-D-22-25441
pmc: PMC9934314
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0281813Informations de copyright
Copyright: © 2023 Dalbeni et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
J Hepatol. 2018 Aug;69(2):406-460
pubmed: 29653741
Ann Hepatol. 2022 Sep-Oct;27(5):100719
pubmed: 35460883
Gastroenterology. 2019 Apr;156(5):1368-1380.e10
pubmed: 30552895
Int J Antimicrob Agents. 2022 Nov-Dec;60(5-6):106672
pubmed: 36103917
Hepatology. 2016 Oct;64(4):1249-64
pubmed: 27483394
Infect Drug Resist. 2022 Mar 15;15:1039-1048
pubmed: 35313728
Am J Gastroenterol. 2011 Jan;106(1):96-103
pubmed: 20823836
Gastroenterology. 2010 Oct;139(4):1246-56, 1256.e1-5
pubmed: 20558165
World J Hepatol. 2012 May 27;4(5):158-68
pubmed: 22662285
JCI Insight. 2017 Oct 5;2(19):
pubmed: 28978799
J Hepatol. 2014 Jun;60(6):1310-24
pubmed: 24530646
Med Clin North Am. 2009 Jul;93(4):819-36, vii
pubmed: 19577116
Clin Infect Dis. 2019 May 2;68(10):e83-e110
pubmed: 30895288
J Hepatol. 2021 Jul;75 Suppl 1:S101-S117
pubmed: 34039482
J Hepatol. 2015 Nov;63(5):1272-84
pubmed: 26192220
Hepatology. 2011 Aug;54(2):555-61
pubmed: 21567436
Liver Int. 2018 Feb;38 Suppl 1:126-133
pubmed: 29427501
Hepatology. 2012 Dec;56(6):2328-35
pubmed: 22806618
J Hepatol. 2014 Feb;60(2):241-2
pubmed: 24211741
J Hepatol. 2019 Mar;70(3):398-411
pubmed: 30391380
J Hepatol. 2006 Jan;44(1):217-31
pubmed: 16298014
J Clin Transl Hepatol. 2021 Feb 28;9(1):32-39
pubmed: 33604253
Hepatology. 2012 May;55(5):1551-61
pubmed: 22183941
Clin Gastroenterol Hepatol. 2011 Sep;9(9):727-38
pubmed: 21397731
Hepatology. 2016 May;63(5):1632-9
pubmed: 26529126
Hepatology. 2007 Jan;45(1):223-9
pubmed: 17187409
J Coll Physicians Surg Pak. 2010 Aug;20(8):514-8
pubmed: 20688015