Multidrug-resistant bacterial infections in patients with liver cirrhosis in a tertiary referral hospital

Gastroenterol Hepatol. 2019 Apr;42(4):228-238. doi: 10.1016/j.gastrohep.2018.07.017. Epub 2018 Oct 17.
[Article in English, Spanish]

Abstract

Introduction: Infections in cirrhotic patients caused by multidrug-resistant bacteria are currently increasing and are associated with greater morbidity and mortality.

Objectives: To assess the epidemiology, risk factors and prognoses of infections caused by multidrug-resistant bacterial infections in cirrhotic patients.

Patients and methods: Retrospective study on patients with liver cirrhosis who developed an infection during hospitalisations between July 2014 and August 2016 at our centre (Hospital Universitari i Politècnic La Fe, Valencia, Spain).

Results: Urinary tract infection (30.2%) and spontaneous bacterial peritonitis (22.1%) were the most common infections. A total of 102 microbiological isolates were analysed: 50% in community-acquired infections, 36% in isolates associated with healthcare infections and 14% in nosocomial infections. Escherichia coli was the main aetiology (29.4%). The overall multiresistance rate was 28.4%. The univariate analysis showed that infection caused by multidrug-resistant bacteria (28.4%) was associated with nosocomial infection compared to those associated with healthcare (OR 5.46; 95% CI: 1.22-24.43; P=.039) and healthcare-associated infections (compared to community-acquired infections, OR 3.39; 95% CI: 1.09-10.54; P=.048), use of antibiotics (OR 4.37; 95% CI: 1.59-11.99; P=.005), hospital admission in the previous 90 days (OR 3.18; 95% CI: 1.19-8.47; P=.018), active cancer (OR 2.93; 95% CI: 1.08-7.99; P=.038), and use of prophylactic norfloxacin (OR 3; 95% CI: 1.02-8.79; P=.012). Moreover, it was associated with a higher rate of sepsis (OR 3.13; 95% CI: 1.18-8.32; P=.025). The failure of initial treatment was related to greater development of acute renal failure (P<.001), sepsis (P=.012), septic shock (P=.002), ICU admission (P<.001) and mortality (P<.001).

Conclusion: The rate of multidrug-resistant bacteria infections in our centre is comparable to that of other European centres with similar characteristics. The results obtained make it recommendable to implement the antibiotic treatment guidelines in current clinical practice guidelines, limiting the use of carbapenems to nosocomial infections and healthcare-associated infections with other risk factors of multidrug resistance or signs of severe sepsis. Early and adequate empirical treatment correlates with a better prognosis.

Keywords: Bacterial infections/epidemiology; Cirrosis hepática; Factores de riesgo; Farmacorresistencia bacteriana múltiple; Infecciones bacterianas/epidemiología; Liver cirrhosis; Multidrug-resistant bacterial; Risk factors.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bacterial Infections / complications*
  • Bacterial Infections / drug therapy*
  • Bacterial Infections / microbiology
  • Drug Resistance, Multiple, Bacterial
  • Female
  • Humans
  • Liver Cirrhosis / complications*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tertiary Care Centers