Management of Multidrug-Resistant Infections in Cirrhosis

Gallaher, Charles E; Shawcross, Debbie L.

doi:10.1055/a-1765-0056

Cited by 3 publications

(4 citation statements)

References 119 publications

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“…Current or recent contact with the healthcare system is another important risk factor for MDR infections. A strong association between MDR infections and hospital admission has been shown in several studies[ 10 , 26 , 27 ]. Patients with nosocomial infection, hospitalization for more than 48 h, and those discharged in the last 30 d are at increased risk for MDR infections.…”

Section: Risk Factors For Multidrug Resistant Bacterial Infectionsmentioning

confidence: 92%

“…MDR risk is also related to the site of the infection. For example, MDR infections were more commonly observed in patients with pneumonia, skin and soft tissue infections than in those with SBP or spontaneous bacteremia[ 7 , 27 ].…”

Section: Risk Factors For Multidrug Resistant Bacterial Infectionsmentioning

confidence: 99%

“…The main non-pharmacological measures focus on gut microbiota[ 27 ]. A healthy microbiome is essential to prevent colonization and infection by MDRO[ 25 ].…”

Section: Managementmentioning

confidence: 99%

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Impact of multidrug resistance on the management of bacterial infections in cirrhosis

Terra¹,

Mattos²,

Chagas³

et al. 2023

World J Clin Cases

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Patients with cirrhosis have an increased risk of infection and differently from other complications, that over the years are improving in their outcomes, infections in cirrhotic patients are still a major cause of hospitalization and death (up to 50% in-hospital mortality). Infections by multidrug-resistant organisms (MDRO) have become a major challenge in the management of cirrhotic patients with significant prognostic and cost-related impact. About one third of cirrhotic patients with bacterial infections is infected with MDR bacteria and their prevalence has increased in recent years. MDR infections have a worse prognosis compared to infections by non-resistant bacteria because they are associated with lower rate of infection resolution. An adequate management of cirrhotic patients with infections caused by MDR bacteria depends on the knowledge of some epidemiological aspects, such as the type of infection (spontaneous bacterial peritonitis, pneumonia, urinary tract infection and spontaneous bacteremia), bacteriological profile of antibiotic resistance at each health care unit and site of infection acquisition (community acquired, healthcare associated or nosocomial). Furthermore, regional variations in the prevalence of MDR infections determine that the choice of empirical antibiotic therapy must be adapted to the local microbiological epidemiology. Antibiotic treatment is the most effective measure to treat infections caused by MDRO. Therefore, optimizing antibiotic prescribing is critical to effectively treat these infections. Identification of risk factors for multidrug resistance is essential to define the best antibiotic treatment strategy in each case and the choice of an effective empirical antibiotic therapy and its early administration is cardinal to reduce mortality. On the other hand, the supply of new agents to treat these infections is very limited. Thus, specific protocols that include preventive measures must be implemented in order to limit the negative impact of this severe complication in cirrhotic patients.

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Section: Risk Factors For Multidrug Resistant Bacterial Infectionsmentioning

confidence: 92%

Section: Risk Factors For Multidrug Resistant Bacterial Infectionsmentioning

confidence: 99%

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Impact of multidrug resistance on the management of bacterial infections in cirrhosis

Terra¹,

Mattos²,

Chagas³

et al. 2023

World J Clin Cases

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“…Antimicrobial treatment in patients with liver diseases is a clinical challenge, as these patients are often characterized by a high risk of serious infections and a less favorable risk/benefit profile [ 110 , 111 ]. Infections represent the most common and life-threatening complication of liver cirrhosis, with an overall incidence ranging from 25 to 40% in patients with decompensated cirrhosis [ 112 ].…”

Section: Clinical Profile Of Older Patients At Risk Of Adverse Events...mentioning

confidence: 99%

Safety and Tolerability of Antimicrobial Agents in the Older Patient

et al. 2023

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Older patients are at high risk of infections, which often present atypically and are associated with high morbidity and mortality. Antimicrobial treatment in older individuals with infectious diseases represents a clinical challenge, causing an increasing burden on worldwide healthcare systems; immunosenescence and the coexistence of multiple comorbidities determine complex polypharmacy regimens with an increase in drug–drug interactions and spread of multidrug-resistance infections. Aging-induced pharmacokinetic and pharmacodynamic changes can additionally increase the risk of inappropriate drug dosing, with underexposure that is associated with antimicrobial resistance and overexposure that may lead to adverse effects and poor adherence because of low tolerability. These issues need to be considered when starting antimicrobial prescriptions. National and international efforts have been made towards the implementation of antimicrobial stewardship (AMS) interventions to help clinicians improve the appropriateness and safety of antimicrobial prescriptions in both acute and long-term care settings. AMS programs were shown to decrease consumption of antimicrobials and to improve safety in hospitalized patients and older nursing home residents. With the abundance of antimicrobial prescriptions and the recent emergence of multidrug resistant pathogens, an in-depth review of antimicrobial prescriptions in geriatric clinical practice is needed. This review will discuss the special considerations for older individuals needing antimicrobials, including risk factors that shape risk profiles in geriatric populations as well as an evidence-based description of antimicrobial-induced adverse events in this patient population. It will highlight agents of concern for this age group and discuss interventions to mitigate the effects of inappropriate antimicrobial prescribing.

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Infections in decompensated cirrhosis: Pathophysiology, management, and research agenda

Ferguson Toll,

Solà,

Perez

et al. 2024

Hepatology Communications

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Bacterial infections in patients with cirrhosis lead to a 4-fold increase in mortality. Immune dysfunction in cirrhosis further increases the risk of bacterial infections, in addition to alterations in the gut microbiome, which increase the risk of pathogenic bacteria. High rates of empiric antibiotic use contribute to increased incidence of multidrug-resistant organisms and further increases in mortality. Despite continous advances in the field, major unknowns regarding interactions between the immune system and the gut microbiome and strategies to reduce infection risk and improve mortality deserve further investigation. Here, we highlight the unknowns in these major research areas and make a proposal for a research agenda to move toward improving disease progression and outcomes in patients with cirrhosis and infections.

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Management of Multidrug-Resistant Infections in Cirrhosis

Cited by 3 publications

References 119 publications

Impact of multidrug resistance on the management of bacterial infections in cirrhosis

Impact of multidrug resistance on the management of bacterial infections in cirrhosis

Safety and Tolerability of Antimicrobial Agents in the Older Patient

Infections in decompensated cirrhosis: Pathophysiology, management, and research agenda

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