title: Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study.
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.
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain. Jfdez@clinic.ub.es
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández
authors.forename: Juan
authors.initials: J
authors.lastname: Acevedo
authors.forename: Miriam
authors.initials: M
authors.lastname: Castro
authors.forename: Orlando
authors.initials: O
authors.lastname: Garcia
authors.forename: Carlos Rodríguez
authors.initials: CR
authors.lastname: de Lope
authors.forename: Daria
authors.initials: D
authors.lastname: Roca
authors.forename: Marco
authors.initials: M
authors.lastname: Pavesi
authors.forename: Elsa
authors.initials: E
authors.lastname: Sola
authors.forename: Leticia
authors.initials: L
authors.lastname: Moreira
authors.forename: Anibal
authors.initials: A
authors.lastname: Silva
authors.forename: Tiago
authors.initials: T
authors.lastname: Seva-Pereira
authors.forename: Francesco
authors.initials: F
authors.lastname: Corradi
authors.forename: Jose
authors.initials: J
authors.lastname: Mensa
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D001618:beta-Lactamases