• DOI:10.1053/j.gastro.2018.12.005
• Corpus ID: 55702158

Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide.

@article{Piano2019EpidemiologyAE,
  title={Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide.},
  author={Salvatore Piano and Virendra Singh and Paolo Caraceni and Rakhi Maiwall and Carlo Alessandria and Javier Fern{\'a}ndez and Elza Cotrim Soares and Dong Joon Kim and Sung Eun Kim and M{\'o}nica Marino and Julio D. Vorobioff and R. Ribeiro Barea and Manuela Merli and Laure Elkrief and Victor Vargas and Aleksander Krag and Shivaram Prasad Singh and Laurentius A Lesmana and Claudio Toledo and Sebasti{\'a}n Marciano and Xavier Verhelst and Florence Wong and Nicolas M. Intagliata and Liane Rabinowich and Luis Colombato and Sang Gyune Kim and Alexander L. Gerbes and François Paquet Durand and Juan Pablo Roblero and Kalyan Ram Bhamidimarri and Thomas D. Boyer and Marina Maevskaya and Eduardo Fassio and Hyoung Su Kim and Jae Seok Hwang and Pere Gin{\`e}s and Adrian Gadano and Shiv Kumar Sarin and Paolo Angeli and Michele Bartoletti and Carlos Eduardo Brodersen and Tony Bruns and Robert A de Man and A. D. Fialla and Carmine Gabriele Gambino and Vikas Gautam and Marcos Girala and Adri{\`a} Juanola and Jeong Han Kim and Tae Hun Kim and Pramod Kumar and Barbara Lattanzi and Tae Hee Lee and Cosmas A. Rinaldi Lesmana and Richard Moreau and Preetam Nath and Gustavo Navarro and Ji-Won Park and Gisela Pinero and Nikolaos T Pyrsopoulos and Sophie Restellini and Gustavo A Romero and Marco Sacco and Tiago Sev{\'a}-Pereira and Macarena Sim{\'o}n-Talero and Do Seon Song and Ki Tae Suk and Hans Van Vlierberghe and Sun Young Yim and Eileen L. Yoon and Giacomo Zaccherini},
  journal={Gastroenterology},
  year={2019},
  volume={156 5},
  pages={
          1368-1380.e10
        }
}

• S. Piano, Virendra Singh, +68 authors G. Zaccherini
• Published 1 April 2019
• Medicine, Biology
• Gastroenterology

BACKGROUND & AIMS
Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis.

METHODS
We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge.

RESULTS
The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%-37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival.

CONCLUSIONS
In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.