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The spread of multi drug resistant infections is leading to an increase in the empirical antibiotic treatment failure in cirrhosis: a prospective survey.

ABSTRACT: The spread of multi-resistant infections represents a continuously growing problem in cirrhosis, particularly in patients in contact with the healthcare environment.Our prospective study aimed to analyze epidemiology, prevalence and risk factors of multi-resistant infections, as well as the rate of failure of empirical antibiotic therapy in cirrhotic patients.All consecutive cirrhotic patients hospitalized between 2008 and 2013 with a microbiologically-documented infection (MDI) were enrolled. Infections were classified as Community-Acquired (CA), Hospital-Acquired (HA) and Healthcare-Associated (HCA). Bacteria were classified as Multidrug-Resistant (MDR) if resistant to at least three antimicrobial classes, Extensively-Drug-Resistant (XDR) if only sensitive to one/two classes and Pandrug-Resistant (PDR) if resistant to all classes.One-hundred-twenty-four infections (15% CA, 52% HA, 33% HCA) were observed in 111 patients. Urinary tract infections, pneumonia and spontaneous bacterial peritonitis were the more frequent. Forty-seven percent of infections were caused by Gram-negative bacteria. Fifty-one percent of the isolates were multi-resistant to antibiotic therapy (76% MDR, 21% XDR, 3% PDR): the use of antibiotic prophylaxis (OR = 8.4; 95%CI = 1.03-76; P = 0,05) and current/recent contact with the healthcare-system (OR = 3.7; 95%CI = 1.05-13; P = 0.04) were selected as independent predictors. The failure of the empirical antibiotic therapy was progressively more frequent according to the degree of resistance. The therapy was inappropriate in the majority of HA and HCA infections.Multi-resistant infections are increasing in hospitalized cirrhotic patients. A better knowledge of the epidemiological characteristics is important to improve the efficacy of empirical antibiotic therapy. The use of preventive measures aimed at reducing the spread of multi-resistant bacteria is also essential.

SUBMITTER: Merli M

PROVIDER: S-EPMC4440761 | biostudies-other | 2015

REPOSITORIES: biostudies-other

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Project description:Background & aimsThere are limited data on the prevalence or predictors of antibiotic-resistant bacterial infections (AR-BI) in hospitalized patients with cirrhosis in North America. Exposure to systemic antibiotics is a risk factor for AR-BI; however, little is known about the effects of the increasingly used oral nonabsorbed antibiotics.MethodsWe analyzed data from patients with cirrhosis and bacterial infections hospitalized in a liver unit at a US hospital between July 2009 and November 2010. Multivariate logistic regression was used to determine predictors of AR-BI. Data were analyzed on the first bacterial infection of each patient (n = 115), and a sensitivity analysis was performed on all infectious episodes per patient (n = 169).ResultsThirty percent of infections were nosocomial. Urinary tract infections (32%) and spontaneous bacterial peritonitis (24%) were most common. Of the 70 culture-positive infections, 33 (47%) were found to be antibiotic resistant (12 were vancomycin-resistant Enterococci, 9 were extended-spectrum ?-lactamase-producing Enterobacteriaceae, 7 were quinolone-resistant gram-negative rods, and 5 were methicillin-resistant Staphylococcus aureus). Exposure to systemic antibiotics within 30 days before infection was associated independently with AR-BI, with an odds ratio (OR) of 13.5 (95% confidence interval [CI], 2.6-71.6). Exposure to only nonabsorbed antibiotics (rifaximin) was not associated with AR-BI (OR, 0.4; 95% CI, 0.04-2.8). In a sensitivity analysis, exposure to systemic antibiotics within 30 days before infection and nosocomial infection was associated with AR-BI (OR, 5.2; 95% CI, 1.5-17.7; and OR, 4.2; 95% CI, 1.4-12.5, respectively).ConclusionsThe prevalence of AR-BI is high in a US tertiary care transplant center. Exposure to systemic antibiotics within 30 days before infection (including those used for prophylaxis of spontaneous bacterial peritonitis), but not oral nonabsorbed antibiotics, is associated with development of an AR-BI.

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The spread of multi drug resistant infections is leading to an increase in the empirical antibiotic treatment failure in cirrhosis: a prospective survey.

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