Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe

Autor: Fernandez, J., Prado, V., Trebicka, J., Amoros, A., Gustot, T., Wiest, R., Deulofeu, C., Garcia, E., Acevedo, J., Fuhrmann, V., Durand, F., Sanchez, C., Papp, M., Caraceni, P., Vargas, V., Banares, R., Piano, S., Janicko, M., Albillos, A., Alessandria, C., Soriano, G., Welzel, T.M., Laleman, W., Gerbes, A., Gottardi, A. de, Merli, M., Coenraad, M., Saliba, F., Pavesi, M., Jalan, R., Gines, P., Angeli, P., Arroyo, V., European Fdn Study Chronic Liver
Přispěvatelé: Fernández, Javier, Prado, Verónica, Trebicka, Jonel, Amoros, Alex, Gustot, Thierry, Wiest, Reiner, Deulofeu, Carme, Garcia, Elisabet, Acevedo, Juan, Fuhrmann, Valentin, Durand, Françoi, Sánchez, Cristina, Papp, Maria, Caraceni, Paolo, Vargas, Victor, Bañares, Rafael, Piano, Salvatore, Janicko, Martin, Albillos, Agustin, Alessandria, Carlo, Soriano, German, Welzel, Tania M., Laleman, Wim, Gerbes, Alexander, De Gottardi, Andrea, Merli, Manuela, Coenraad, Minneke, Saliba, Faouzi, Pavesi, Marco, Jalan, Rajiv, Ginès, Pere, Angeli, Paolo, Arroyo, Vicente
Jazyk: angličtina
Rok vydání: 2019
Předmět:
0301 basic medicine
Liver Cirrhosis
Male
Cirrhosis
antibiotic resistance
Epidemiology
Antibiotic resistance
Antibiotics
antibiotic strategies
Antibiotic strategies
0302 clinical medicine
Risk Factors
Drug Resistance
Multiple
Bacterial
Outcome Assessment
Health Care
Prevalence
Gastro-entérologie
Prospective Studies
610 Medicine & health
Prognosis
Hepatology
Cross Infection
Bacterial Infections
Middle Aged
Anti-Bacterial Agents
Europe
Hospitalization
Disease Progression
030211 gastroenterology & hepatology
Female
epidemiology
medicine.medical_specialty
medicine.drug_class
Prognosi
prevalence
03 medical and health sciences
Spontaneous bacterial peritonitis
Pharmacotherapy
Internal medicine
medicine
Humans
Bacteria
business.industry
Bacterial pneumonia
Acute-On-Chronic Liver Failure
medicine.disease
Pneumonia
030104 developmental biology
prognosis
business
Antibiotic strategie
Zdroj: JOURNAL OF HEPATOLOGY
r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname
Fernández, Javier; Prado, Verónica; Trebicka, Jonel; Amoros, Alex; Gustot, Thierry; Wiest, Reiner; Deulofeu, Carme; Garcia, Elisabet; Acevedo, Juan; Fuhrmann, Valentin; Durand, François; Sánchez, Cristina; Papp, Maria; Caraceni, Paolo; Vargas, Victor; Bañares, Rafael; Piano, Salvatore; Janicko, Martin; Albillos, Agustin; Alessandria, Carlo; ... (2019). Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe. Journal of hepatology, 70(3), pp. 398-411. Elsevier 10.1016/j.jhep.2018.10.027
Journal of hepatology, 70 (3
Journal of Hepatology, 70(3), 398-411
ISSN: 0168-8278
DOI: 10.1016/j.jhep.2018.10.027
Popis: Background & Aims: Antibiotic resistance has been increasingly reported in patients with decompensated cirrhosis in single-center studies. Prospective investigations reporting broad epidemiological data are scarce. We aimed to analyze epidemiological changes in bacterial infections in patients with decompensated cirrhosis. Methods: This was a prospective evaluation of 2 series of patients hospitalized with decompensated cirrhosis. The Canonic series included 1,146 patients from Northern, Southern and Western Europe in 2011. Data on epidemiology, clinical characteristics of bacterial infections, microbiology and empirical antibiotic schedules were assessed. A second series of 883 patients from Eastern, Southern and Western Europe was investigated between 2017–2018. Results: A total of 455 patients developed 520 infections (39.7%) in the first series, with spontaneous bacterial peritonitis, urinary tract infections and pneumonia the most frequent infections. Nosocomial episodes predominated in this series. Nearly half of the infections were culture-positive, of which 29.2% were caused by multidrug-resistant organisms (MDROs). MDR strains were more frequently isolated in Northern and Western Europe. Extended-spectrum beta-lactamase-producing Enterobacteriaceae were the most frequent MDROs isolated in this series, although prevalence and type differed markedly among countries and centers. Antibiotic resistance was associated with poor prognosis and failure of antibiotic strategies, based on third-generation cephalosporins or quinolones. Nosocomial infection (odds ratio [OR] 2.74; p < 0.001), intensive care unit admission (OR 2.09; p = 0.02), and recent hospitalization (OR 1.93; p = 0.04) were identified as independent predictors of MDR infection. The prevalence of MDROs in the second series (392 infections/284 patients) was 23%; 38% in culture-positive infections. A mild increase in the rate of carbapenem-resistant Enterobacteriaceae was observed in this series. Conclusions: MDR bacterial infections constitute a prevalent, growing and complex healthcare problem in patients with decompensated cirrhosis and acute-on-chronic liver failure across Europe, negatively impacting on prognosis. Strategies aimed at preventing the spread of antibiotic resistance in cirrhosis should be urgently evaluated. Lay summary: Infections caused by bacteria resistant to the main antibiotic families are prevalent in patients with cirrhosis. This study demonstrates that this healthcare problem is increasing and extends through all European regions. Infections caused by these difficult to treat bacteria resolve less frequently and often cause the death of the patient. The type of resistant bacteria varies markedly among different hospitals.
SCOPUS: ar.j
info:eu-repo/semantics/published
Databáze: OpenAIRE
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