A prospective multicentre study of the epidemiology and outcomes of bloodstream infection in cirrhotic patients

Bartoletti, Michele; Giannella, Maddalena; Lewis, Russell E.; Caraceni, Paolo; Tedeschi, Sara; Paul, Mical; Schramm, C; Bruns, Tony; Merli, Manuela; Cobos-Trigueros, Nazaret; Seminari, Elena; Retamar, Pilar; Muñóz, Patricia; Tumbarello, Mario; Burra, Patrizia; Cerenzia, M. Torrani; Baršić, Bruno; Calbo, Esther; Maraolo, Alberto Enrico; Petrosillo, Nicola; Galan-Ladero, Maria Angeles; D’Offizi, Gianpiero; Sinai, N. Bar; Rodríguez-Baño, Jesús; Verucchi, Gabriella; Bernardi, Mauro; Viale, Pierluigi; Campoli, Caterina; Siccardi, Guido; Ambretti, Simone; Stallmach, Andreas; Venditti, Mario; Lucidi, C.; Ludovisi, Serena; Cueto, Marina de; Navarro, M.D.; Cortés, E.; Bouza, Emilio; Valerio, Maricela; Eworo, Alia; Losito, Raffaella; Senzolo, Marco; Nadal, E.; Ottobrelli, A.; Varguvic, Martina; Badía, Cristina; Borgia, Guglielmo; Gentile, Ivan; Buonomo, Antonio Riccardo; Boumis, Evangelo; Beteta-Lopez, Alicia; Rianda, Alessia; Taliani, Gloria; Grieco, Stefania

doi:10.1016/j.cmi.2017.08.001

Cited by 82 publications

(97 citation statements)

References 21 publications

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“…Furthermore, the infectious episodes were, in the majority of cases, hospital acquired or healthcare related, due to MDR bacteria with a high rate of failure of the first empirical antibiotic treatment. This setting has been frequently reported in our country where the prevalence of infections from MDR bacteria is rather high …”

Section: Discussionmentioning

confidence: 76%

A low muscle mass increases mortality in compensated cirrhotic patients with sepsis

Lucidi

Lattanzi

Gregorio

et al. 2018

Liver International

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Section: Discussionmentioning

confidence: 76%

A low muscle mass increases mortality in compensated cirrhotic patients with sepsis

Lucidi

Lattanzi

Gregorio

et al. 2018

Liver International

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“…Here, we present a secondary analysis of the BICHROME study, a prospective multicenter study conducted in 19 tertiary centers from Italy (n = 10), Spain (n = 5), Germany (n = 2), Croatia (n = 1), and Israel (n = 1) from September 2014 to December 2015 designed to describe the current epidemiology of BSI in cirrhotic patients [6]. The core BICHROME study enrolled consecutive adult (aged >18 years) cirrhotic patients with BSI.…”

Section: Methodsmentioning

confidence: 99%

“…The diagnosis of liver cirrhosis was based on previous liver biopsy results or a composite of clinical signs and findings provided by laboratory test results, endoscopy, and radiologic imaging. Eligible patients were prospectively screened by study coordinators at each site through microbiological and admission records at the local liver units as previously described [6]. The study was approved by all local institutional review boards of the participating hospitals.…”

Section: Methodsmentioning

confidence: 99%

“…Approximately 20% of all infections that require hospital admission in patients with liver cirrhosis are due to primary or secondary bacteremia with associated mortality rates between 25% and 58% [5,6], which is significantly higher than that in noncirrhotic patients with bacteremia [7,8]. Several things may explain the higher mortality, including cirrhosis-associated immune deficiency, the high rate of acute-on-chronic liver failure (ACLF) syndrome triggered by infections, and a higher prevalence of multidrug-resistant (MDR) pathogens [2,5,9].…”

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confidence: 99%

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Extended Infusion of β-Lactams for Bloodstream Infection in Patients With Liver Cirrhosis: An Observational Multicenter Study

Bartoletti

Giannella

Lewis

et al. 2019

Clinical Infectious Diseases

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Background We analyzed the impact of continuous/extended infusion (C/EI) vs intermittent infusion of piperacillin-tazobactam (TZP) and carbapenems on 30-day mortality of patients with liver cirrhosis and bloodstream infection (BSI). Methods The BICRHOME study was a prospective, multicenter study that enrolled 312 cirrhotic patients with BSI. In this secondary analysis, we selected patients receiving TZP or carbapenems as adequate empirical treatment. The 30-day mortality of patients receiving C/EI or intermittent infusion of TZP or carbapenems was assessed with Kaplan-Meier curves, Cox-regression model, and estimation of the average treatment effect (ATE) using propensity score matching. Results Overall, 119 patients received TZP or carbapenems as empirical treatment. Patients who received C/EI had a significantly lower mortality rate (16% vs 36%, P = .047). In a Cox-regression model, the administration of C/EI was associated with a significantly lower mortality (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.11–0.936; P = .04) when adjusted for severity of illness and an ATE of 25.6% reduction in 30-day mortality risk (95% CI, 18.9–32.3; P < .0001) estimated with propensity score matching. A significant reduction in 30-day mortality was also observed in the subgroups of patients with sepsis (HR, 0.21; 95% CI, 0.06–0.74), acute-on-chronic liver failure (HR, 0.29; 95% CI, 0.03–0.99), and a model for end-stage liver disease score ≥25 (HR, 0.26; 95% CI, 0.08–0.92). At competing risk analysis, C/EI of beta-lactams was associated with significantly higher rates of hospital discharge (subdistribution hazard [95% CI], 1.62 [1.06–2.47]). Conclusions C/EI of beta-lactams in cirrhotic patients with BSI may improve outcomes and facilitate earlier discharge.

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“…Appropriate initial antibiotic therapy has been demonstrated as the key independent factor of treatment outcomes in patients with Gram-negative bacteremia in previous studies from the adult ICUs or wards [11][12][13][14]. However, this issue has not been fully studied in the NICU, except for a small sample size, case-control study found in the literature [15].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Initial Inappropriate Antibiotic Therapy and the Impacts on Outcomes of Neonates with Gram-Negative Bacteremia

et al. 2020

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Background: Timely appropriate empirical antibiotic plays an important role in critically ill patients with gram-negative bacteremia. However, the relevant data and significant impacts have not been well studied in the neonatal intensive care unit (NICU). Methods: An 8-year (1 January 2007–31 December 2014) cohort study of all NICU patients with gram-negative bacteremia (GNB) in a tertiary-care medical center was performed. Inadequate empirical antibiotic therapy was defined when a patient did not receive any antimicrobial agent to which the causative microorganisms were susceptible within 24 h of blood culture sampling. Neonates with GNB treated with inadequate antibiotics were compared with those who received initial adequate antibiotics. Results: Among 376 episodes of Gram-negative bacteremia, 75 (19.9%) received inadequate empirical antibiotic therapy. The cause of inadequate treatment was mostly due to the pathogen resistance to prescribed antibiotics (88.0%). Bacteremia caused by Pseudomonas aeruginosa (Odds ratio [OR]: 20.8, P < 0.001) and extended spectrum β-lactamase (ESBL)-producing bacteria (OR: 18.4, P < 0.001) had the highest risk of inadequate treatment. Previous exposure with third generation cephalosporin was identified as the only independent risk factor (OR: 2.52, 95% CI: 1.18–5.37, P = 0.018). Empirically inadequately treated bacteremias were significantly more likely to have worse outcomes than those with adequate therapy, including a higher risk of major organ damage (20.0% versus 6.6%, P < 0.001) and infectious complications (25.3% versus 9.3%, P < 0.001), and overall mortality (22.7% versus 11.0%, P = 0.013). Conclusions: Inadequate empirical antibiotic therapy occurs in one-fifth of Gram-negative bacteremias in the NICU, and is associated with worse outcomes. Additional prospective studies are needed to elucidate the optimal timing and aggressive antibiotic regimen for neonates who are at risk of antibiotic-resistant Gram-negative bacteremia.

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A prospective multicentre study of the epidemiology and outcomes of bloodstream infection in cirrhotic patients

Cited by 82 publications

References 21 publications

A low muscle mass increases mortality in compensated cirrhotic patients with sepsis

A low muscle mass increases mortality in compensated cirrhotic patients with sepsis

Extended Infusion of β-Lactams for Bloodstream Infection in Patients With Liver Cirrhosis: An Observational Multicenter Study

Risk Factors of Initial Inappropriate Antibiotic Therapy and the Impacts on Outcomes of Neonates with Gram-Negative Bacteremia

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