title: Infections complicating severe alcoholic hepatitis: Enterococcus species represent the most frequently identified pathogen.
abstract: BACKGROUND
  Patients with acute alcoholic steatohepatitis are at a high risk for infections. To date, neither disease-specific pathogen patterns, nor typical sites of infection, nor antibiotic treatment strategies have been established for AH.
  
  
  OBJECTIVE
  To characterize incidence of infections, pathogen spectrum, sites of infection, and related mortality of patients with AH under steroid therapy.
  
  
  METHODS
  We retrospectively analyzed clinical data of 73 patients with severe alcoholic hepatitis (MELD ≥ 20).
  
  
  RESULTS
  Infections were detected in 45 patients (73%). Patients who developed an infection after initiation of corticosteroid therapy had a higher 6-month mortality than patients without onset of infection after initiation of corticosteroid treatment (44% versus 24%, p = 0.116). The pathogen identified most frequently was Enterococcus species.
  
  
  CONCLUSIONS
  Infections frequently complicate severe alcoholic hepatitis and affect survival. The high rate of Enterococcus infections suggests that commonly used antibiotics, such as cephalosporins and quinolones, may represent an ineffective choice of empiric antibiotic treatment for complicated AH.
authors.affiliation: a Department of Internal Medicine I, Gastroenterology, Hepatology and Infectious Diseases , Hamburg University Medical Center , Hamburg , Germany ;|b DZIF Partner Site (German Center for Infection Research) , Braunschweig , Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Beisel
authors.affiliation: a Department of Internal Medicine I, Gastroenterology, Hepatology and Infectious Diseases , Hamburg University Medical Center , Hamburg , Germany ;
authors.forename: Usha
authors.initials: U
authors.lastname: Blessin
authors.affiliation: a Department of Internal Medicine I, Gastroenterology, Hepatology and Infectious Diseases , Hamburg University Medical Center , Hamburg , Germany ;|b DZIF Partner Site (German Center for Infection Research) , Braunschweig , Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Schulze Zur Wiesch
authors.affiliation: a Department of Internal Medicine I, Gastroenterology, Hepatology and Infectious Diseases , Hamburg University Medical Center , Hamburg , Germany ;
authors.forename: Malte H
authors.initials: MH
authors.lastname: Wehmeyer
authors.affiliation: a Department of Internal Medicine I, Gastroenterology, Hepatology and Infectious Diseases , Hamburg University Medical Center , Hamburg , Germany ;
authors.forename: Ansgar W
authors.initials: AW
authors.lastname: Lohse
authors.affiliation: a Department of Internal Medicine I, Gastroenterology, Hepatology and Infectious Diseases , Hamburg University Medical Center , Hamburg , Germany ;
authors.forename: Daniel
authors.initials: D
authors.lastname: Benten
authors.affiliation: a Department of Internal Medicine I, Gastroenterology, Hepatology and Infectious Diseases , Hamburg University Medical Center , Hamburg , Germany ;
authors.forename: Johannes
authors.initials: J
authors.lastname: Kluwe
mesh_terms: D000328:Adult; D000368:Aged; D016983:Enterococcus; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000401:mortality; D006519:Hepatitis, Alcoholic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use
chemical_list: D013256:Steroids; D011239:Prednisolone
keywords: Alcoholic hepatitis; Enterococcus species; fungal infection; infection