title: The spread of multi drug resistant infections is leading to an increase in the empirical antibiotic treatment failure in cirrhosis: a prospective survey.
abstract: BACKGROUND
  The spread of multi-resistant infections represents a continuously growing problem in cirrhosis, particularly in patients in contact with the healthcare environment.
  
  
  OBJECTIVE
  Our prospective study aimed to analyze epidemiology, prevalence and risk factors of multi-resistant infections, as well as the rate of failure of empirical antibiotic therapy in cirrhotic patients.
  
  
  METHODS
  All consecutive cirrhotic patients hospitalized between 2008 and 2013 with a microbiologically-documented infection (MDI) were enrolled. Infections were classified as Community-Acquired (CA), Hospital-Acquired (HA) and Healthcare-Associated (HCA). Bacteria were classified as Multidrug-Resistant (MDR) if resistant to at least three antimicrobial classes, Extensively-Drug-Resistant (XDR) if only sensitive to one/two classes and Pandrug-Resistant (PDR) if resistant to all classes.
  
  
  RESULTS
  One-hundred-twenty-four infections (15% CA, 52% HA, 33% HCA) were observed in 111 patients. Urinary tract infections, pneumonia and spontaneous bacterial peritonitis were the more frequent. Forty-seven percent of infections were caused by Gram-negative bacteria. Fifty-one percent of the isolates were multi-resistant to antibiotic therapy (76% MDR, 21% XDR, 3% PDR): the use of antibiotic prophylaxis (OR = 8.4; 95%CI = 1.03-76; P = 0,05) and current/recent contact with the healthcare-system (OR = 3.7; 95%CI = 1.05-13; P = 0.04) were selected as independent predictors. The failure of the empirical antibiotic therapy was progressively more frequent according to the degree of resistance. The therapy was inappropriate in the majority of HA and HCA infections.
  
  
  CONCLUSIONS
  Multi-resistant infections are increasing in hospitalized cirrhotic patients. A better knowledge of the epidemiological characteristics is important to improve the efficacy of empirical antibiotic therapy. The use of preventive measures aimed at reducing the spread of multi-resistant bacteria is also essential.
authors.affiliation: Gastroenterology, Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Merli
authors.affiliation: Gastroenterology, Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Lucidi
authors.affiliation: Gastroenterology, Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Vincenza
authors.initials: V
authors.lastname: Di Gregorio
authors.affiliation: Department of Infectious disease, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Falcone
authors.affiliation: Gastroenterology, Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Giannelli
authors.affiliation: Gastroenterology, Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Lattanzi
authors.affiliation: Gastroenterology, Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Giusto
authors.affiliation: Department of Infectious disease, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Ceccarelli
authors.affiliation: Department of Public Health and Infectious Diseases, Statistics Section, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Farcomeni
authors.affiliation: Gastroenterology, Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Oliviero
authors.initials: O
authors.lastname: Riggio
authors.affiliation: Department of Infectious disease, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Venditti
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D017714:Community-Acquired Infections; D003428:Cross Infection; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015995:Prevalence; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents