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Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: A prospective study

Authors

  • Javier Fernández,

    Corresponding author
    1. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
    2. Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
    • Liver Unit, Hospital Clínic, Villarroel 170, 08036 Barcelona. Spain
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    • fax: 34-93-4515522

  • Juan Acevedo,

    1. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
    2. Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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  • Miriam Castro,

    1. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
    2. Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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  • Orlando Garcia,

    1. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
    2. Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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  • Carlos Rodríguez de Lope,

    1. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
    2. Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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  • Daria Roca,

    1. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
    2. Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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  • Marco Pavesi,

    1. Statistical Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
    2. Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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  • Elsa Sola,

    1. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
    2. Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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  • Leticia Moreira,

    1. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
    2. Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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  • Anibal Silva,

    1. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
    2. Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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  • Tiago Seva-Pereira,

    1. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
    2. Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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  • Francesco Corradi,

    1. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
    2. Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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  • Jose Mensa,

    1. Infectious Disease Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
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  • Pere Ginès,

    1. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
    2. Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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  • Vicente Arroyo

    1. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
    2. Institut d'Investigacions Biomèdiques August-Pi-Sunyer, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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  • Potential conflict of interest: Nothing to report.

Abstract

Epidemiology, risk factors, and clinical effect of infections by multiresistant bacteria in cirrhosis are poorly known. This work was a prospective evaluation in two series of cirrhotic patients admitted with infection or developing infection during hospitalization. The first series was studied between 2005 and 2007 (507 bacterial infections in 223 patients) and the second between 2010 and 2011 (162 bacterial infections in 110 patients). In the first series, 32% of infections were community acquired (CA), 32% healthcare associated (HCA), and 36% nosocomial. Multiresistant bacteria (92 infections; 18%) were isolated in 4%, 14%, and 35% of these infections, respectively (P < 0.001). Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E; n = 43) was the main multiresistant organism identified, followed by Pseudomonas aeruginosa (n = 17), methicillin-resistant Staphylococcus aureus (n = 14), and Enterococcus faecium (n = 14). The efficacy of currently recommended empirical antibiotic therapy was very low in nosocomial infections (40%), compared to HCA and CA episodes (73% and 83%, respectively; P < 0.0001), particularly in spontaneous bacterial peritonitis, urinary tract infection, and pneumonia (26%, 29%, and 44%, respectively). Septic shock (26% versus 10%; P < 0.0001) and mortality rate (25% versus 12%; P = 0.001) were significantly higher in infections caused by multiresistant strains. Nosocomial origin of infection (hazard ratio [HR], 4.43), long-term norfloxacin prophylaxis (HR, 2.69), recent infection by multiresistant bacteria (HR, 2.45), and recent use of β-lactams (HR, 2.39) were independently associated with the development of multiresistant infections. Results in the second series were similar to those observed in the first series. Conclusions: Multiresistant bacteria, especially ESBL-producing Enterobacteriaceae, are frequently isolated in nosocomial and, to a lesser extent, HCA infections in cirrhosis, rendering third-generation cephalosporins clinically ineffective. New antibiotic strategies tailored according to the local epidemiological patterns are needed for the empirical treatment of nosocomial infections in cirrhosis. (HEPATOLOGY 2012)

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