Antibiotic stewardship and empirical antibiotic treatment: How can they get along?

Zuccaro, Valentina; Columpsi, Paola; Sacchi, Paolo; Lucà, Maria Grazia; Fagiuoli, Stefano; Bruno, Raffaele

doi:10.1016/j.dld.2017.01.157

Cited by 13 publications

(8 citation statements)

References 31 publications

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“…Since MDRO infections often develop in the sickest, hospitalized patients with cirrhosis, organ dysfunction, and prior non-MDRO bacterial infections, the antibiotic stewardship remains paramount for preventing the emergence of resistant rods before LT [12,55]. This might include an accurate evaluation of the local epidemiological trends of bacterial infections using a multidisciplinary approach encompassing infectious disease specialists, anesthesiologists, transplant surgeons, pharmacists and hepatologists, and tailored treatment algorithms [56,57].…”

Section: Strategies To Prevent and Treat Multidrug Bacterial Infections In The Setting Of Liver Transplantationmentioning

confidence: 99%

Multidrug-Resistant Bacterial Infections before and after Liver Transplantation

Ferrarese¹,

Senzolo²,

Burra³

2020

OBM Transplantation

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Bacterial infection represents a common event in the natural history of cirrhosis, especially in patients with end-stage liver disease. An episode of bacterial infection may significantly modify a patient's outcome in the setting of liver transplantation (LT) by impairing hepatic and extrahepatic organ functions, both in pre-operative and post-operative phases. Infections caused by multidrug-resistant organisms (MDRO) are increasing in cirrhosis due to high antibiotic exposure and hospitalizations. This issue is particularly important in the LT setting, where MDRO infections occurring before surgery and during the early days after surgery might significantly impair graft function and patient outcome. This review summarizes the recently published findings on the occurrence of MDRO infection before and after LT, and new perspectives for its prevention and treatment.

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Section: Strategies To Prevent and Treat Multidrug Bacterial Infections In The Setting Of Liver Transplantationmentioning

confidence: 99%

Multidrug-Resistant Bacterial Infections before and after Liver Transplantation

Ferrarese¹,

Senzolo²,

Burra³

2020

OBM Transplantation

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“…Each individual patient may have complexities within their clinical situation, requiring thoughtful prophylactic regimens. However, these results do underscore the importance of compliance with antimicrobial stewardship, a necessary clinical adjunct to combat the rise of multidrug‐resistant organisms by requiring de‐escalation of therapy once pathogens and sensitivities are known . This is particularly important in the OLT population, where gram‐positive and gram‐negative multidrug‐resistant organisms have a prevalence of >50% .…”

Section: Discussionmentioning

confidence: 99%

“…However, these results do underscore the importance of compliance with antimicrobial stewardship, a necessary clinical adjunct to combat the rise of multidrug-resistant organisms by requiring de-escalation of therapy once pathogens and sensitivities are known. (29) This is particularly important in the OLT population, where gram-positive and gram-negative multidrug-resistant organisms have a prevalence of >50%. (30) Therefore, minimizing unnecessary exposure to prolonged perioperative surgical antibiotic prophylaxis may decrease postoperative multidrug-resistant infections.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Versus Extended Antibiotic Prophylaxis in Liver Transplant Surgery: A Randomized Controlled Pilot Trial

Berry

Rosenberger²,

Guidry

et al. 2019

Liver Transpl

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The appropriate duration of surgical antibiotic prophylaxis in orthotopic liver transplantation (OLT) in the presence of significant iatrogenic immunosuppression is unclear. We hypothesized that 72 hours of perioperative antibiotic prophylaxis would decrease rates of surgical site infection (SSI) in OLT patients when compared with intraoperative antibiotic prophylaxis alone. OLT recipients were randomized to receive either intraoperative antibiotics only (short antibiotics [SAs]) or 72 hours of perioperative antibiotics (extended antibiotics [EAs]). A total of 102 patients were randomized: 51 to the EA group and 51 to the SA group. Rates of SSI and nosocomial infection (NI) in the SA group were 19% and 17%, respectively, compared with 27% (SSI; P = 0.36) and 22% (NI; P = 0.47) in the EA group, although these differences were not statistically significant. Intensive care unit (ICU) length of stay (LOS), hospital LOS, 30‐day mortality, and time to infection were also similar between the 2 groups. Patients developing infections had longer ICU LOS and hospital LOS and a higher association with reoperation, endoscopic retrograde cholangiopancreatography, and 30‐day readmission. In conclusion, extending perioperative antibiotics to 72 hours from intraoperative dosing alone in OLT patients does not appear to decrease the incidence of SSI or NI. The results from this pilot trial with 60% power suggest that it is acceptable for OLT recipients to receive intraoperative antibiotic prophylaxis alone.

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“…However, it can lead to antibiotic resistance, potentially exacerbating the situation in the longer run. 28 Understanding local antibiotic resistance patterns is important to tailoring empiric regimens that will improve survival outcomes without unnecessarily increasing risks for antibiotic resistance.…”

Section: Discussionmentioning

confidence: 99%

Bacterial Infections in Cirrhotic Patients in a Tertiary Care Hospital

Lingiah

Pyrsopoulos

2020

Journal of Clinical and Translational Hepatology

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Background and Aims Patients with cirrhosis are immunocompromised and at higher risk of developing infections compared to the general population. The aim of this study was to assess the incidence of infections in cirrhotic patients in a large academic liver center and investigate potential associations between infections, bacteria isolated, therapeutic regimens used, and mortality. Methods This was a retrospective chart review study, including 192 patients. All patients had a diagnosis of cirrhosis and were admitted to University Hospital. Information collected included demographics, etiology of cirrhosis, identification of bacteria from cultures, multidrug-resistant (MDR) status, antibiotics administered, intensive care unit (ICU) admission, and patient mortality. Results Infections were present in 105 (54.6%) patients, and 60 (31.2%) patients had multiple infections during a hospitalization(s) for infections. A total of 201 infections were identified. Urinary tract infections (UTIs) were the most common infection (37.8%), followed by bacteremia (20.4%), pneumonia (12.9%), spontaneous bacterial peritonitis (SBP) (11.9%), abscess/cellulitis (6.0%), infectious diarrhea (6.0%), and other (5.0%). Escherichia coli was the most common bacteria isolated (13.4%), both among sensitive and MDR infections. MDR bacteria were the cause for 41.3% of all infections isolated. Fungi accounted for 9.5% of infections. 21.9% of patients had decompensation from their infection(s) that required ICU care, and 14.6% of patients died during hospitalization or soon after discharge. Conclusions The incidence of infections in cirrhotic patients is much higher than in their non-cirrhotic counterparts (54.6%), even higher than prior studies suggest. As many of these infections are caused by MDR bacteria and fungal organisms, stronger empiric antibiotics and antifungals should be considered when initially treating this immunocompromised population. However, once organism sensitivities are discovered, narrowing of antibiotic regimens must occur to maintain good antibiotic stewardship.

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Antibiotic stewardship and empirical antibiotic treatment: How can they get along?

Cited by 13 publications

References 31 publications

Multidrug-Resistant Bacterial Infections before and after Liver Transplantation

Multidrug-Resistant Bacterial Infections before and after Liver Transplantation

Intraoperative Versus Extended Antibiotic Prophylaxis in Liver Transplant Surgery: A Randomized Controlled Pilot Trial

Bacterial Infections in Cirrhotic Patients in a Tertiary Care Hospital

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