Epidemiology of hospital-acquired infections in cirrhotic patients: effect of carriage of methicillin-resistant Staphylococcus aureus and influence of previous antibiotic therapy and norfloxacin prophylaxis

Abstract

We assessed the prevalence of carriage of methicillin-resistant Staphylococcus aureus (MRSA) in anterior nares and stools, and of third-generation cephalosporin resistant enterobacteriaceae and non-fermenting gram-negative bacilli (RE/RNF) in stools of 748 hospitalized long-stay cirrhotic patients. We also evaluated the consequences of carriage on the epidemiology of hospital-acquired spontaneous bacterial peritonitis, bacteraemia and urinary tract infection (UTI) in these patients. The prevalence of carriage of MRSA and RE/RNF was 16.7% and 14.7% respectively. Whereas RE/RNF carriage did not lead to an increased risk of infection due to RE/RNF, the overall risk of infections caused by MRSA was more than tenfold higher in MRSA carriers. MRSA and RE/RNF carriers had received prior antibiotic therapy to a greater extent than non-carriers (P < 0.001) and MRSA carriers had received prior norfloxacin prophylaxis to a greater extent than the two other groups (P < 0.02). The mortality rate during hospital stay was higher in MRSA and RE/RNF carriers than in non-carriers (P < 0.001). Pugh score (P < 0.0001), age (P < 0.0001), MRSA carriage (P = 0.0018) and bacteraemia (P = 0.0017) were associated independently with mortality. MRSA carriage in hospitalized cirrhotic patients leads to the emergence of infections due to this strain, mainly SBP and bacteraemia. Prior antibiotic therapy and norfloxacin prophylaxis increase the risk of carriage of MRSA.

Length of exposure to the hospital environment is more important than antibiotic exposure in healthcare associated infections by methicillin-resistant Staphylococcus aureus: a comparative study

“…These results are in agreement with prior studies, looking at qualitative use of those antibiotics. 6,11,12,14,22,[26][27][28][29][33][34][35][36][37][38] Additionally, use of at least two different antibiotics during the previous month was at the border of statistical significance. The underlying mechanisms have not been completely clarified but several lines of evidence exist.…”

“…[1][2][3] MRSA infections cause significant morbidity and mortality and increased length of hospital stay and cost of care. [4][5][6][7][8] Risk factors for healthcare-associated MRSA acquisition and infection include age, duration of hospitalization, underlying disease, neonatal or adult ICU or burn unit location, invasive procedures or devices, previous hospitalization, intensity of care, number of inter-ward transfers, coma, low physical function, serum albumin, pressure sores, immunosuppression, proximity to a MRSA-colonized patient, underlying dermatological disease, enteral feedings. 4,[9][10][11][12][13][14][15][16][17][18] The issue of antibiotic use as a risk factor is complex and still not completely clarified in full detail.…”

“…[11][12][13][14][15][16][17][18]24,25 Included in these classes are β-lactamic antibiotics, 14,26-33 cephalosporins, 11,12,16,22,29 aminoglycosides, 22,33,34 macrolides, 27 glycopeptides 15,[27][28][29]34 and fluoroquinolones (FQs). 6,11,12,14,[26][27][28][29][35][36][37] A relatively recently published meta-analysis detected a clear association between exposure to antibiotics and MRSA isolation. Significant risk ratios were found for FQs, glycopeptides, cephalosporins and other β-lactams.…”

Concentrations in Plasma, Urinary Excretion, andBactericidal Activity of Linezolid (600 Milligrams) versusThose of Ciprofloxacin (500 Milligrams) inHealthy Volunteers Receiving a Single OralDose

“…Thus, the bactericidal activities of linezolid and ciprofloxacin against susceptible strains in urine were comparable, whereas linezolid also exhibited the same good bactericidal activity against ciprofloxacin-resistant strains. Therefore, linezolid should be tested for use as empirical treatment for complicated urinary tract infections due to gram-positive uropathogens in an appropriate clinical trial.The incidence of nosocomial and complicated urinary tract infections (UTIs) caused by gram-positive bacteria resistant to the antibiotics available at present is increasing (7,19). Thus, gram-positive bacteria deserve more attention today than they did in the past.…”

Prevention strategies for methicillin-resistant Staphylococcus aureus (MRSA) in Latin America

“…Over-use of cephalosporins [62][63][64][65] and fluoroquinolones 66,67 has been associated with MRSA selection in some settings, and quinolone use has been linked with prolongation of MRSA carriage. The role of these agents for resistant of S. epidermidis is well recognized, especially with quinolones.…”