title: The prognostic significance of bacterial DNA in patients with decompensated cirrhosis and suspected infection.
abstract: Circulating and peritoneal fragments of microbial DNA (bactDNA) are evidence for bacterial translocation in decompensated cirrhosis and may serve as a rational approach for antibiotic therapy when infection is suspected.
  
  
  
  Prospective multicenter study to investigate whether identification of bactDNA from blood or ascitic fluid (AF) by multiplex polymerase chain reaction (PCR) is associated with increased 90-day mortality in 218 patients with cirrhosis and signs of infection.
  
  
  
  BactDNA in either compartment was detected in 134 (61%) patients, comprising 54 with bactDNA in blood and AF, 48 with AF bactDNA only, and 32 with blood bactDNA only. BactDNA was associated with spontaneous bacterial peritonitis and blood stream infections (SBP/BSI), acute-on-chronic liver failure (ACLF), encephalopathy and markers of inflammation. The prevalence of bactDNA in patients with proven SBP/BSI (36/49; 73%) was similar to that in patients with sterile ACLF (37/52; 71%). Actuarial 90-day survival was 56 ± 5% in the absence of bactDNA in both compartments and did not differ if bactDNA was detected in blood only (63 ± 9%), AF only (63 ± 7%), or in blood and AF (52 ± 7%). Predictors of 90-day mortality were SBP (HR = 3.10; 95% CI: 1.90-5.06), BSI (HR = 4.94; 95% CI: 2.71-9.02), and ACLF (HR = 2.20; 95% CI: 1.44-3.35). The detection of resistance genes in blood or AF in the absence of SBP/BSI (n = 11) was associated with poor 1-year survival (HR = 2.35; 95% CI: 1.03-5.35).
  
  
  
  BactDNA in sterile body fluids did not indicate increased mortality in cirrhotic patients with suspected infection. Using multiplex PCR for risk stratification cannot be recommended in these patients.
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.|Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany.
authors.forename: Tony
authors.identifier: 0000-0002-5576-6914
authors.initials: T
authors.lastname: Bruns
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.|Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany.
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Reuken
authors.affiliation: Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Stengel
authors.affiliation: Department of Internal Medicine I, Frankfurt University Hospital, Frankfurt, Germany.
authors.forename: Ludmila
authors.initials: L
authors.lastname: Gerber
authors.affiliation: Department of Internal Medicine II, Saarland University Hospital, Homburg, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Appenrodt
authors.affiliation: Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany.
authors.forename: Johannes H
authors.initials: JH
authors.lastname: Schade
authors.affiliation: Department of Internal Medicine II, Saarland University Hospital, Homburg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Lammert
authors.affiliation: Department of Internal Medicine I, Frankfurt University Hospital, Frankfurt, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.|Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Stallmach
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000382:microbiology; D000368:Aged; D001201:Ascites / Q000382:microbiology; D001202:Ascitic Fluid / Q000382:microbiology; D018988:Bacterial Translocation; D015415:Biomarkers; D004269:DNA, Bacterial / Q000097:blood*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000150:complications* / Q000382:microbiology; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D062606:Tertiary Care Centers
chemical_list: D015415:Biomarkers; D004269:DNA, Bacterial
keywords: ascites; bacterial DNA; bacterial translocation; chronic liver disease