Intestinal colonization with resistant bacteria: a prognostic marker of mortality in decompensated cirrhosis

Abstract

Infections due to drug-resistant (DR) bacteria are increasingly recognized as an emerging problem worldwide. Asymptomatically colonized patients may contribute to the reservoir in the hospital setting, causing both horizontal transmission and endogenous infections. We aimed to evaluate the prevalence of intestinal colonization with DR bacteria on subsequent clinical infection development and prognosis in patients with decompensated cirrhosis. One hundred seven patients without infection at baseline were screened and prospectively followed-up for 3 months. Among the patients screened, DR bacteria were isolated in 47 (43.9%), 14 colonized with multidrug- (MDR) and 33 with extensively drug (XDR)-resistant bacteria or a mixture of MDR/XDR bacteria. Severity of liver disease and demographic characteristics were similar among groups. The 20 (42.6%) with DR vs 14 (23.3%) without had hepatic encephalopathy and/or spontaneous bacterial peritonitis episodes over the past 6 months (p = 0.034). One third of both DR and non-DR groups developed infection during follow-up but in only 7 and 5, respectively, the infection was microbiologically documented. In a 3-month-follow-up period, mortality was higher in patients colonized with XDR compared to those without (log rank p = 0.027). In multivariate analysis, colonization with XDR bacteria [HR = 1.074, (CI:1.024-1.126), p = 0.003] and MELD score [HR = 2.579 (1.109-5.996), p = 0.028] were independently associated with low survival. Asymptomatic GI colonization with DR bacteria is a risk factor for increased mortality in decompensated cirrhosis. Frequent hospitalizations for complications of the underlying disease and selective pressure induced by the use of antimicrobials are probably the main determinants.

Spontaneous bacterial and fungal peritonitis in patients with liver cirrhosis: A literature review

“…Bacterial metabolites that reach the liver through portal system activate toll-like receptors (TLRs)[ 18 ], and the genetic polymorphism of TLR and nucleotide-binding oligomerization domain 2 genes may also be involved in the pathogenesis of BT, thus increasing the risk of infection in patients with LC by altering TLR binding to lipopolysaccharides or endotoxins[ 13 , 16 ]. Finally, intestinal colonization and translocation of drug-resistant bacteria may induce MDR SBP infections[ 19 , 20 ].…”

“…In two series of patients with LC evaluated in 2005-2007 and 2011-2012, Fernández et al[ 33 ] reported that MDR bacteria were more common in nosocomial infections and were associated with higher in-hospital mortality than in infections caused by antibiotic-susceptible bacteria. Pouriki et al[ 20 ] reported drug-resistant bacteria in intestinal cultures from 44% of uninfected patients with decompensated LC. Recent reports have found that asymptomatic intestinal colonization with MDR or XDR bacteria was an increased mortality risk in patients with LC in part because of BT of circulation of bacterial components[ 20 ].…”

“…Pouriki et al[ 20 ] reported drug-resistant bacteria in intestinal cultures from 44% of uninfected patients with decompensated LC. Recent reports have found that asymptomatic intestinal colonization with MDR or XDR bacteria was an increased mortality risk in patients with LC in part because of BT of circulation of bacterial components[ 20 ].…”

The Mucosally-Adherent Rectal Microbiota Contains Features Unique to Alcohol-Related Cirrhosis

“… 17 , 18 It has been utilized to characterize the gut microbiota in healthy adults and infants as well as in diseased states including inflammatory bowel diseases, acute pancreatitis, and critical illness. 17–21 Although rectal swabs have been used in cirrhosis to detect specific drug-resistant pathogens using traditional culture techniques, 22 , 23 to our knowledge, no study has utilized rectal swab to comprehensively survey the gut microbiome via sequencing-based technologies in cirrhosis. In this study, we set out to compare luminal and mucosally adherent gut microbiota in cirrhosis via stool and rectal swab, respectively, using shotgun metagenomic sequencing, with the notion that observed differences might be reflective of the different microenvironments in which they reside.…”

The Use of Moxisaxin for Treatment of a Decompensated Cirrhosis Patient with Severe Pulmonary Infection

“…Bacterial infections are frequent complications in patients with decompensated cirrhosis, and are the most frequent triggers of spontaneous bacterial peritonitis, urinary tract infections, pneumonia, and cellulitis (1). Bacterial infection, a risk that is magnified in these patients, increases the rate of short-term mortality, being the most frequent cause of death (2). Recently, multidrug-resistant (MDR) bacterial infections are in an alarming increase in patients with decompensated cirrhosis (3).…”