Bacterial distributions and prognosis of bloodstream infections in patients with liver cirrhosis

Abstract

Bloodstream infections (BSIs) are a frequently observed complication in liver cirrhosis patients. This study aimed to investigate the microbiological characteristics and outcomes of BSIs in patients with liver cirrhosis. We retrospectively studied 852 patients with liver cirrhosis who developed a BSI. Patient outcome was evaluated using 30-day mortality and assessed using multivariate stepwise logistic regression analysis. Antibiotic sensitivity of the pathogens was tested. Gram-negative bacteria were responsible for 59.6% of BSIs, and Gram-positive bacteria caused 40.4% of the episodes among liver cirrhosis patients. The bacterial distribution significantly differed between hospital-acquired and community-acquired infections, especially in cases caused by Gram-negative pathogens. The results of the drug sensitivity test suggested that amikacin, cefoperazone/sulbactam, and piperacillin/tazobactam highly suppressed Gram-negative infections, while vancomycin and teicoplanin strongly inhibited Gram-positive BSIs. Liver failure, liver cancer, complications, Child-Pugh grade, septic shock, administration of appropriate antibiotics within 24 h, ICU admission, nosocomial infection, and Gram nature of the bacteria were independent risk factors for 30-day mortality (P < 0.05). The choice of initial empirical antibiotics should be based on the type, severity and origin of infection and on the local epidemiological data on antibiotic resistance. Accurate evaluation of risk factors for mortality may improve appropriate therapeutic choice.

Determination of Antimicrobial Resistance Patterns in Bloodstream Infections-Isolated Bacteria From a University Tertiary Hospital Patients

“…29 Further, imipenem represented the most activity against all strains. These results are in conformity with the reported data from India, Brazil, and China, as well as the results obtained by Haddad et al about imipenem and its efficacy against the strains in the intensive care unit (30)(31)(32)(33)(34)(35). Furthermore, in the present study, the most resistance of S. aureus to antibiotics was reported to ceftriaxone and gentamicin and the most resistance of coagulase-negative staphylococci was related to ofloxacin, levofloxacin, and cefotaxime.…”

Investigation on outcomes and bacterial distributions of liver cirrhosis patients with gram-negative bacterial bloodstream infection

“…In our early study [ 19 ], Escherichia coli was the most common pathogen, which accounted for 48.23% and was followed by Klebsiella pneumoniae (19.29%). Some other common isolates included Aeromomas species (5.91%), Enterobacter cloacae (3.74%), Acinetobacter baumanii (3.15%), Pseudomonas aeruginosa (1.77%), Stenotrophomonas maltophilia (1.18%), and others (14.76%).…”

“…The interaction between the two pathophysiological conditions may lead to excessive growth of intestinal flora, thus causing the occurrence of BSI. Although the managements of cirrhosis have been improved, the incidence rate of BSI is still high [ 19 ]. Once the infection and multiple complications such as septic shock occur, it will be followed by organ failures.…”

Cefoperazone/sulbactam therapeutic drug monitoring in patients with liver cirrhosis: Potential factors affecting the pharmacokinetic/pharmacodynamic target attainment

“…Cefoperazone/sulbactam highly inhibits the most common isolates of Escherichia coli, Klebsiella pneumoniae and is commonly used for the treatment of Acinetobacter baumannii infection. Therefore, some countries have recommended cefoperazone/sulbactam as the initial empirical treatment regimen for cirrhotic patients with infections …”

“…Therefore, some countries have recommended cefoperazone/sulbactam as the initial empirical treatment regimen for cirrhotic patients with infections. 6,7 Cefoperazone/sulbactam is a combination containing betalactamase inhibitors and has a time-dependent antibacterial activity, which is related to the per cent of time in which free drug concentration exceeds the minimal inhibitory concentration (MIC) of the organism (%fT > MIC). Clinically, 100% fT > MIC could be considered as a stringent pharmacokinetic/ pharmacodynamic (PK/PD) target to maximize clinical efficacy of cephalosporins treatment.…”