title: The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study.
abstract: Bacterial strains resistant to antibiotics are a serious clinical challenge. We assessed the antibiotic susceptibility of bacteria isolated from infections in patients with cirrhosis by a multicentre investigation.
  
  
  
  Three hundred and thirteen culture-positive infections (173 community acquired [CA] and 140 hospital acquired [HA]) were identified in 308 patients. Urinary tract infections, spontaneous bacterial peritonitis and bacteremias were the most frequent. Quinolone-resistant Gram-negative isolates were 48%, 44% were extended-spectrum beta-lactamase producers and 9% carbapenem resistant. In 83/313 culture-positive infections (27%), multidrug-resistant agents (MDRA) were isolated. This prevalence did not differ between CA and HA infections. MDRA were identified in 17 of 37 patients on quinolone prophylaxis, and in 46 of 166 not on prophylaxis (45% vs 27%; P<.03). In 287 cases an empiric antibiotic therapy was undertaken, in 37 (12.9%) this therapy failed. The in-hospital mortality rate of this subset of patients was significantly higher compared to patients who received an effective broad(er)-spectrum therapy (P=.038). During a 3-month follow-up, 56/203 culture-positive patients (27.6%) died, 24/63 who have had MDRA-related infections (38%) and 32/140 who have had antibiotic-susceptible infections (22.8%) (P=.025). Multivariate analysis disclosed MDRA infection, age, hepatocellular carcinoma, bilirubin, international normalized ratio and the occurrence of portal hypertension-related complications independent predictors of death.
  
  
  
  Infection by MDRA is frequent in patients with cirrhosis and the prognosis is severe, especially in patients unresponsive to empiric antibiotic therapy.
authors.affiliation: Medicina Interna, IRCCS San Donato, Università degli studi di Milano, San Donato Milanese, Milano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Salerno
authors.affiliation: Unità di Gastroenterologia e Microbiologia, Ospedale Predabissi, Melegnano, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Borzio
authors.affiliation: Unità di Gastroenterologia e Microbiologia, Ospedale Predabissi, Melegnano, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Pedicino
authors.affiliation: Unità di Medicina 2, Ospedali Riuniti, Villa Sofia Cervello, Palermo, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Simonetti
authors.affiliation: Unità di Epatologia, Dipartimento di Medicina, Azienda Ospedaliera Spedali Civili, Brescia, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Rossini
authors.affiliation: Unità di Gastroenterologia, Azienda Universitaria Ospedaliera di Ferrara, Ferrara, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Boccia
authors.affiliation: Unità di Epatologia Clinica e Biomolecolare, Policlinico Universitario, Messina, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Cacciola
authors.affiliation: Sheila Sherlock Liver Center, Royal Free Hospital, London, UK.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
authors.affiliation: Gastroenterologia-1, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Matteo A
authors.initials: MA
authors.lastname: Manini
authors.affiliation: Medicina Interna, IRCCS San Donato, Università degli studi di Milano, San Donato Milanese, Milano, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: La Mura
authors.affiliation: Medicina Clinica e Sperimentale, Policlinico Universitario, Padova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
authors.affiliation: Unità di Semeiotica Medica, Department of Clinical Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Bernardi
authors.affiliation: Sezione di Malattie Infettive, Dipartimento di Medicina Clinica, Università dell'Insubria, Varese, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Dalla Gasperina
authors.affiliation: Unità di Gastroenterologia e Microbiologia, Ospedale Predabissi, Melegnano, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Dionigi
authors.affiliation: Unità di Gastroenterologia e Microbiologia, Ospedale Predabissi, Melegnano, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Dibenedetto
authors.affiliation: Unità di Gastroenterologia e Microbiologia, Ospedale Predabissi, Melegnano, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Arghittu
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008103:Liver Cirrhosis / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: bacterial resistance; cirrhosis; portal hypertension; survival