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Clinical Trial
. 2015 Apr;13(4):753-9.e1-2.
doi: 10.1016/j.cgh.2014.07.060. Epub 2014 Aug 12.

Long-term use of antibiotics and proton pump inhibitors predict development of infections in patients with cirrhosis

Jacqueline G O'Leary  1 , K Rajender Reddy  2 , Florence Wong  3 , Patrick S Kamath  4 , Heather M Patton  5 , Scott W Biggins  6 , Michael B Fallon  7 , Guadalupe Garcia-Tsao  8 , Ram M Subramanian  9 , Raza Malik  10 , Leroy R Thacker  11 , Jasmohan S Bajaj  12 ; North American Consortium for the Study of End-Stage Liver Disease
Affiliations
Clinical Trial

Long-term use of antibiotics and proton pump inhibitors predict development of infections in patients with cirrhosis

Jacqueline G O'Leary et al. Clin Gastroenterol Hepatol. 2015 Apr.

Abstract

Background & aims: Bacterial infections, particularly repeated infections, are significant causes of morbidity and mortality among patients with cirrhosis. We investigated and characterized risk factors for repeat infections in these patients.

Methods: In a prospective study, we collected data from 188 patients hospitalized with cirrhosis and infections and enrolled in the North American Consortium for the Study of End-Stage Liver Disease (12 centers). Patients were followed up for 6 months after hospital discharge and data were analyzed on type of infections and factors associated with subsequent infections.

Results: Six months after hospital discharge, 14% of subjects had received liver transplants, 27% died, and 59% were alive without liver transplantation. After discharge, 45% had subsequent infections, but only 26% of the subsequent infections occurred at the same site. Compared with patients not re-infected, patients with repeat infections were older and a higher proportion used proton pump inhibitors (PPIs) (P = .006), rifaximin (P < .001), or prophylactic therapy for spontaneous bacterial peritonitis (SBP) (P < .001). Logistic regression showed that SBP prophylaxis (odds ratio [OR], 3.44; 95% confidence interval [CI], 1.56-7.63), PPI use (OR, 2.94; 95% CI, 1.39-6.20), SBP at hospital admission (OR, 0.37; 95% CI, 0.15-0.91), and age (OR, 1.06; 95% CI, 1.02-1.11) were independent predictors of subsequent infections.

Conclusions: Patients hospitalized with cirrhosis and infections are at high risk for subsequent infections, mostly at different sites, within 6 months of index infection resolution. Those at highest risk include previously infected older patients receiving PPIs and/or SBP prophylaxis, although these associations do not prove that these factors cause the infections. New strategies are needed to prevent infections in patients with cirrhosis.

Keywords: Antibiotic; Complication; Decompensation; NACSELD.

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Conflict of interest statement

Disclosures: No author has any pertinent competing interests to disclose relevant to this paper.

Figures

Figure 1
Figure 1
Outcome of patients enrolled in the NACSELD trial.
Figure 2
Figure 2
Frequency of first and subsequent infections occurring in the same location within 6 months of hospital discharge with an infection.
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