Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe

Fernández, Javier; Prado, Verónica; Trebicka, Jonel; Amorós, Àlex; Gustot, Thierry; Wiest, Reiner; Deulofeu, Carme; García, Elisabet; Acevedo, Juan; Fuhrmann, Valentin; Durand, François; Sánchez, Cristina Díaz; Papp, Mária; Caraceni, Paolo; Vargas, Vı́ctor; Bañares, Rafael; Piano, Salvatore; Janíčko, Martin; Albillos, Agustı́n; Alessandria, Carlo; Soriano, Germán; Welzel, Tania M.; Laleman, Wim; Gerbes, Alexander L.; Gottardi, Andrea De; Merli, Manuela; Coenraad, Minneke J.; Saliba, Faouzi; Pavesi, Marco; Jalan, Rajiv; Ginès, Pere; Angeli, Paolo; Arroyo, Vicente

doi:10.1016/j.jhep.2018.10.027

Cited by 284 publications

(338 citation statements)

References 44 publications

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“…The presence of MDR infection at admission was the independent predictor of 28‐day mortality in AD of cirrhosis after adjusting for disease severity scores. The data corroborate with the existing literature on infections in cirrhosis …”

Section: Discussionsupporting

confidence: 90%

“…Whereas, in the USA, the dominant MDROs are methicillin‐resistant S. aureus and vancomycin‐resistant enterococci . The predominant time of acquisition in our study was nosocomial, consistent with literature …”

Section: Discussionsupporting

confidence: 90%

“…Indian study also showed MDROs in 41% of culture‐positive infections in cirrhotics . SBP, UTI, and pneumonia were identified as the most frequent sites of infection by MDROs in European series . However, we found spontaneous bacteremia, UTI, SBP, and pneumonia as the commonest site of infections by MDROs.…”

Section: Discussionmentioning

confidence: 43%

“…Fernandez et al . showed increased rate of septic shock and mortality in MDR infections in cirrhosis . Global study demonstrated higher septic shock, intensive care unit admission, organ failures, and mortality in MDR infections as compared with non‐MDR infections.…”

Section: Discussionmentioning

confidence: 93%

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Prediction of 28‐day mortality in acute decompensation of cirrhosis through the presence of multidrug‐resistant infections at admission

Gupta

Lochan

Verma

et al. 2019

J of Gastro and Hepatol

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Background and Aim The aim of this study is to evaluate the epidemiology and impact of bacterial infections at admission in patients with acute decompensation (AD) of cirrhosis. Methods A cohort with AD of cirrhosis (European Association for the Study of the Liver criteria) admitted at a tertiary center was evaluated between 2013 and 2014 for the presence of bacterial infections at admission. Clinical, demographic, and microbiological data were collected prospectively till death, transplant, or 90 days. Results Of 179 patients with AD, 102 (56.9%) had bacterial infections at admission. The commonest infections were spontaneous bacterial peritonitis (SBP) (n = 65; 63.7%), spontaneous bacteremia (n = 10; 9.8%), pneumonia (n = 9; 8.8%), urinary tract infection (n = 8; 7.8%), spontaneous bacterial empyema (n = 4; 3.9%), and cellulitis (n = 2; 1.9%). The commonest source was community acquired (n = 85; 83.3%). Serum albumin and sodium levels were lower in infected as compared with non‐infected cohort (P = 0.015; for both). Escherichia coli was the commonest organism isolated from SBP (n = 14; 21.5%), urinary tract infection (n = 5; 45.5%), and bacteremia (n = 3; 20%). There was a trend toward higher 28‐day mortality in infected cohort as compared with non‐infected cohort (48 [52.7%] vs 28 [32%]; P = 0.152). Multidrug‐resistant organisms (MDROs) were isolated in 63% of all culture‐positive infections. The presence of MDRO was an independent predictor of 28‐day mortality. Conclusions Infections are the leading reason for the occurrence of AD; SBP is the most common infection, and E. coli is the commonest microorganism based on this single‐center study of Indian patients with AD of cirrhosis. There is a high prevalence of MDROs among culture‐positive infections that independently predict 28‐day mortality in AD of cirrhosis.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 43%

Section: Discussionmentioning

confidence: 93%

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Prediction of 28‐day mortality in acute decompensation of cirrhosis through the presence of multidrug‐resistant infections at admission

Gupta

Lochan

Verma

et al. 2019

J of Gastro and Hepatol

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“…Unfortunately, we did not have enough data about albumin use in BI other than SBP. Furthermore, we confirmed that severity of infection, in terms of multiorgan involvement, was a major prognostic determinant, as previously demonstrated . In this regard, MELD score was not an independent predictor of death among patients with BI (HR, 1.02; 95% CI, 0.98‐1.06; P = 0.27), which was probably because of its incapability to capture the severity of multiorgan failure caused by infection …”

Section: Discussionsupporting

confidence: 89%

Outcome of a First Episode of Bacterial Infection in Candidates for Liver Transplantation

Ferrarese¹,

Vitale²,

Sgarabotto³

et al. 2019

Liver Transpl

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Bacterial infection (BI) is a major cause of worsening of liver function and death in patients with cirrhosis who are awaiting liver transplantation (LT). This study aimed to evaluate the outcome of LT candidates after a first episode of BI between January 2006 and December 2014 at Padua University Hospital. Among 876 LT candidates with cirrhosis, 114 (13%) experienced an episode of BI. Of the 114 patients, 79 were male and 35 were female, and the median (interquartile range) age and Model for End‐Stage Liver Disease scores were 58 (12) years and 19 (8), respectively. When compared with matched LT candidates who experienced no BI, they had a higher probability of death (P = 0.004) and a lower probability of undergoing LT (P = 0.01). Considering only patients who recovered from BI within 30 days, their probabilities of death and of undergoing LT were similar to those of matched controls (P = 0.34 and P = 0.43, respectively). The 90‐day post‐LT mortality was equal between groups (P = 0.90). BI was a strong predictor of early death on the waiting list for LT. Conversely, patients who fully recovered from a BI episode within 30 days did not have a higher mortality risk than matched controls without infection.

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Albumin for people with liver cirrhosis and bacterial infections

Simonetti

Gluud

2021

Cochrane Database of Systematic Reviews

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Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe

Cited by 284 publications

References 44 publications

Prediction of 28‐day mortality in acute decompensation of cirrhosis through the presence of multidrug‐resistant infections at admission

Prediction of 28‐day mortality in acute decompensation of cirrhosis through the presence of multidrug‐resistant infections at admission

Outcome of a First Episode of Bacterial Infection in Candidates for Liver Transplantation

Albumin for people with liver cirrhosis and bacterial infections

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