Towards evidence-based empiric antibiotic recommendations for spontaneous infections in patients with cirrhosis.

Autor: Dirchwolf M; Liver Unit, Hospital Privado de Rosario, Presidente Roca 2440, CP 200, Santa Fe, Argentina. Electronic address: mdirchwolf@outlook.com., Gomez Perdiguero G; Liver Unit, Hospital Italiano de Buenos Aires. Tte. Gral. Juan Domingo Perón 4190, CP 1199, Buenos Aires, Argentina., Cairo F; Liver Unit, Solid Organ Transplant Service, El Cruce Hospital. Av. Calchaquí 5401, CP 1888, Buenos Aires, Argentina., Vazquez C; Internal Medicine, Critical Care Unit, Italiano Hospital of Buenos Aires. Tte. Gral. Juan Domingo Perón 4190, CP 1199, Buenos Aires, Argentina., Notari L; Liver Unit, Police Medical Hospital Churruca Visca. Uspallata 3400, CP 1437, Buenos Aires, Argentina., Murga MD; Liver Unit, Angel C. Padilla Hospital. Juan Bautista Alberdi 550, CP 4000, Tucuman, Argentina., Elizondo M; Bi-Institutional Unit for Complex Hepatic Diseases (Militar Hospital - Clinical Hospital), Liver Transplant Program. Av 8 octubre 3020, CP 11600, Montevideo, Uruguay., Bessone F; Liver Unit, Centenario Hospital of Rosario. Urquiza 3100, CP 2000, Santa Fe, Argentina., Agozino M; Liver and Gastroenterology Unit, Guemes Sanatorio. Av Cordoba 3933, CP 1188, Buenos Aires, Argentina., Brutti J; Liver Unit, Alemán Hospital. Av. Pueyrredón 1640, CP 1118, Buenos Aires, Argentina., Zerega AR; Liver Unit, Allende Sanatorio. Obispo Oro 42, CP 5000, Cordoba, Argentina., Pages J; Liver Unit, Austral University Hospital. Av. Pres. Juan Domingo Peron 1500, CP 1629, Buenos Aires, Argentina., Stieben TE; Liver Unit, San Martin Hospital of Parana. Pres. Juan Domingo Perón 450, CP 3100, Entre Rios, Argentina., Calzetta P; Liver and Gastroenterology Unit, Juan A. Fernández Hospital. Av. Cerviño 3356, CP 1425, Buenos Aires, Argentina., Arufe D; Liver Unit, Sagrado Corazón Sanatorio. Bartolomé Mitre 1955, CP 1039, Buenos Aires, Argentina., González Ballerga E; Liver and Gastroenterology Unit, Hospital Clinica Jose de San Martin Clinica. Av. Córdoba 2351, CP 1120, Buenos Aires, Argentina., Giunta D; Instituto Universitario del Hospital Italiano, Buenos Aires. Argentina. Potosí 4265, CP 1199, Buenos Aires, Argentina., Smud A; Infectious Diseases Service, Italiano Hospital of Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, CP 1199, Buenos Aires, Argentina., Osso Sanchez B; Liver Unit, Police Medical Hospital Churruca Visca. Uspallata 3400, CP 1437, Buenos Aires, Argentina., Navarro L; Liver Unit, Solid Organ Transplant Service, El Cruce Hospital. Av. Calchaquí 5401, CP 1888, Buenos Aires, Argentina., Palazzo A; Liver Unit, Angel C. Padilla Hospital. Juan Bautista Alberdi 550, CP 4000, Tucuman, Argentina., Valverde M; Bi-Institutional Unit for Complex Hepatic Diseases (Militar Hospital - Clinical Hospital), Liver Transplant Program. Av 8 octubre 3020, CP 11600, Montevideo, Uruguay., Gadano A; Liver Unit, Hospital Italiano de Buenos Aires. Tte. Gral. Juan Domingo Perón 4190, CP 1199, Buenos Aires, Argentina., Marciano S; Liver Unit, Hospital Italiano de Buenos Aires. Tte. Gral. Juan Domingo Perón 4190, CP 1199, Buenos Aires, Argentina.
Jazyk: angličtina
Zdroj: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver [Dig Liver Dis] 2024 Aug 05. Date of Electronic Publication: 2024 Aug 05.
DOI: 10.1016/j.dld.2024.07.023
Abstrakt: Background: With the emergence of multidrug-resistant infections, healthcare professionals must evaluate the effectiveness of empiric antibiotic treatments.
Aims: To assess the antibiotic susceptibility patterns of microorganisms causing spontaneous infections in patients with cirrhosis and to evaluate the suitability of empiric antibiotic treatments based on major clinical guidelines.
Methods: This cross-sectional study utilized two datasets from prospective studies of patients with cirrhosis and culture-positive spontaneous bacterial infections in Argentina and Uruguay. We estimated susceptibility to commonly used antibiotics and assessed coverage following European and American recommendations.
Results: We analyzed 238 episodes of culture-positive spontaneous infections in 229 patients. When implementing the recommendations for empiric treatment of community-acquired spontaneous infections, ceftazidime would result in 39 % coverage, whereas ceftriaxone would reach 70 %. Cefepime, which is not included in the recommendations, would have provided coverage of 74 %. Using ertapenem for nosocomial infections would have only covered 56 % of these episodes, whereas meropenem or imipenem reached 73 % coverage. Only the combination of meropenem or imipenem plus vancomycin would achieve a coverage surpassing 85 % in healthcare-associated or nosocomial spontaneous bacterial infections.
Conclusions: Our study uncovers inadequate coverage in specific clinical scenarios when adhering to recommendations, underscoring the necessity of guidelines based on local epidemiological data.
Competing Interests: Declaration of competing interest Authors declare no conflict of interests for this article.
(Copyright © 2024. Published by Elsevier Ltd.)
Databáze: MEDLINE
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