Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide

International Club of Ascites Global Study Group

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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.

OriginalsprogEngelsk
TidsskriftGastroenterology
Vol/bind156
Udgave nummer5
Sider (fra-til)1368-1380.e10
ISSN0016-5085
DOI
StatusUdgivet - 1. apr. 2019

Fingeraftryk

Epidemiology
North America
Hospital Mortality
Microbiology
Liver Transplantation
Prospective Studies
Confidence Intervals
Delivery of Health Care
Incidence

Bibliografisk note

Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

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International Club of Ascites Global Study Group. / Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide. I: Gastroenterology. 2019 ; Bind 156, Nr. 5. s. 1368-1380.e10.
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title = "Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide",
abstract = "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.",
keywords = "Global, Resistance, Sepsis, Stewardship, Bacterial Infections/epidemiology, Liver Transplantation, Prevalence, Prognosis, Prospective Studies, Cross-Sectional Studies, Global Health, Hospital Mortality, Humans, Middle Aged, Risk Factors, Mycoses/epidemiology, Male, Time Factors, Drug Resistance, Multiple, Bacterial, Liver Cirrhosis/epidemiology, Adult, Female, Aged, Anti-Bacterial Agents/therapeutic use",
author = "Salvatore Piano and Virendra Singh and Paolo Caraceni and Rakhi Maiwall and Carlo Alessandria and Javier Fernandez and Soares, {Elza Cotrim} and Kim, {Dong Joon} and Kim, {Sung Eun} and Monica Marino and Julio Vorobioff and {de Cassia Ribeiro Barea}, Rita and Manuela Merli and Laure Elkrief and Victor Vargas and Aleksander Krag and Singh, {Shivaram Prasad} and Lesmana, {Laurentius Adrianto} and Claudio Toledo and Sebastian Marciano and Xavier Verhelst and Florence Wong and Nicolas Intagliata and Liane Rabinowich and Luis Colombato and Kim, {Sang Gyune} and Alexander Gerbes and Francois Durand and Roblero, {Juan Pablo} and Bhamidimarri, {Kalyan Ram} and Boyer, {Thomas D} and Marina Maevskaya and Eduardo Fassio and Kim, {Hyoung Su} and Hwang, {Jae Seok} and Pere Gines and Adrian Gadano and Sarin, {Shiv Kumar} and Paolo Angeli and {International Club of Ascites Global Study Group}",
note = "Copyright {\circledC} 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.",
year = "2019",
month = "4",
day = "1",
doi = "10.1053/j.gastro.2018.12.005",
language = "English",
volume = "156",
pages = "1368--1380.e10",
journal = "Gastroenterology",
issn = "0016-5085",
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Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide. / International Club of Ascites Global Study Group.

I: Gastroenterology, Bind 156, Nr. 5, 01.04.2019, s. 1368-1380.e10.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide

AU - Piano, Salvatore

AU - Singh, Virendra

AU - Caraceni, Paolo

AU - Maiwall, Rakhi

AU - Alessandria, Carlo

AU - Fernandez, Javier

AU - Soares, Elza Cotrim

AU - Kim, Dong Joon

AU - Kim, Sung Eun

AU - Marino, Monica

AU - Vorobioff, Julio

AU - de Cassia Ribeiro Barea, Rita

AU - Merli, Manuela

AU - Elkrief, Laure

AU - Vargas, Victor

AU - Krag, Aleksander

AU - Singh, Shivaram Prasad

AU - Lesmana, Laurentius Adrianto

AU - Toledo, Claudio

AU - Marciano, Sebastian

AU - Verhelst, Xavier

AU - Wong, Florence

AU - Intagliata, Nicolas

AU - Rabinowich, Liane

AU - Colombato, Luis

AU - Kim, Sang Gyune

AU - Gerbes, Alexander

AU - Durand, Francois

AU - Roblero, Juan Pablo

AU - Bhamidimarri, Kalyan Ram

AU - Boyer, Thomas D

AU - Maevskaya, Marina

AU - Fassio, Eduardo

AU - Kim, Hyoung Su

AU - Hwang, Jae Seok

AU - Gines, Pere

AU - Gadano, Adrian

AU - Sarin, Shiv Kumar

AU - Angeli, Paolo

AU - International Club of Ascites Global Study Group

N1 - Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - 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.

AB - 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.

KW - Global

KW - Resistance

KW - Sepsis

KW - Stewardship

KW - Bacterial Infections/epidemiology

KW - Liver Transplantation

KW - Prevalence

KW - Prognosis

KW - Prospective Studies

KW - Cross-Sectional Studies

KW - Global Health

KW - Hospital Mortality

KW - Humans

KW - Middle Aged

KW - Risk Factors

KW - Mycoses/epidemiology

KW - Male

KW - Time Factors

KW - Drug Resistance, Multiple, Bacterial

KW - Liver Cirrhosis/epidemiology

KW - Adult

KW - Female

KW - Aged

KW - Anti-Bacterial Agents/therapeutic use

U2 - 10.1053/j.gastro.2018.12.005

DO - 10.1053/j.gastro.2018.12.005

M3 - Journal article

C2 - 30552895

VL - 156

SP - 1368-1380.e10

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

IS - 5

ER -