Multidrug-resistant bacterial infections in cirrhotic patients: an epidemiological study. (2nd November 2018)

• Record Type: Journal Article
• Authors: Zhao, Ruihong; Ma, Jianke; Li, Pengcheng; Fang, Hong; Sun, Shanshan; Wu, Wei; Chen, Jingdan; Zhao, Hong; Jin, Linfeng; Shi, Yu; Sheng, Jifang
• Is Part Of: Expert review of gastroenterology & hepatology. Volume 12:Number 11(2018)
• Page Start: 1167
• Page End: 1174
• Publication Date: 2018-11-02
• Subjects: Bacterial infections -- liver cirrhosis -- multidrug-resistant bacteria -- mortality -- prognosis; Gastroenterology -- Periodicals; Liver -- Diseases -- Periodicals; 616.3
• DOI: 10.1080/17474124.2018.1515627
• Languages: English
• ISSNs: 1747-4124

Abstract

ABSTRACT: Background : The purpose of this study is to describe the epidemiological features of bacterial infections caused by multidrug-resistant (MDR) bacteria in cirrhotic patients and their impact on mortality. Methods : A retrospective study of cirrhotic patients with culture-confirmed bacterial infections was performed between 2011 and 2017. Results : A total of 635 episodes in 563 patients with cirrhosis were included. Bacterial infections caused by MDR isolates accounted for 44.1% (280/635) of the episodes, nearly half of which were hospital acquired (48.4%). The most common MDR isolation site was the respiratory tract (36.4%, 102 episodes), followed by the abdominal cavity (35.4%, 99 episodes). Of the MDR isolates, carbapenem-resistant Enterobacteriaceae (CRE) (91 episodes) were the most common. Patients infected with MDR bacteria had significantly higher mortality than those not infected (25.1% vs 17.4%, p = 0.025). However, this increased mortality could be largely attributed to methicillin-resistant Staphylococcus aureus (MRSA). After adjustment for age, sex, and the model for end-stage liver disease (MELD) score, only MRSA infection was an independent risk factor for 28-day mortality in the multivariable Cox proportional hazard regression model analysis (HR, 2.964, 95% CI (1.175–7.478), p = 0.021). Conclusions : MDR bacterial infections, especially CRE, have become frequent in patients with cirrhosis in recent years, with MRSA infections significantly increasing short-term mortality.