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Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide

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Author(s)
Salvatore PianoVirendra SinghPaolo CaraceniRakhi MaiwallCarlo AlessandriaJavier FernandezElza Cotrim SoaresDong Joon KimSung Eun KimMonica MarinoJulio VorobioffRita de Cassia Ribeiro BareaManuela MerliLaure ElkriefVictor VargasAleksander KragShivaram Prasad SinghLaurentius Adrianto LesmanaClaudio ToledoSebastian MarcianoXavier VerhelstFlorence WongNicolas IntagliataLiane RabinowichLuis ColombatoSang Gyune KimAlexander GerbesFrancois DurandJuan Pablo RobleroKalyan Ram BhamidimarriThomas D. BoyerMarina MaevskayaEduardo FassioHyoung Su KimJae Seok HwangPere GinesAdrian GadanoShiv Kumar SarinPaolo Angeli
Keimyung Author(s)
Hwang, Jae Seok
Department
Dept. of Internal Medicine (내과학)
Journal Title
Gastroenterology
Issued Date
2019
Volume
156
Issue
5
Keyword
GlobalResistanceSepsisStewardship
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 3months 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 inhospital 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 prevalenceof infectionwithMDRbacteria 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.
Keimyung Author(s)(Kor)
황재석
Publisher
School of Medicine (의과대학)
Citation
Salvatore Piano et al. (2019). Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide. Gastroenterology, 156(5), 1368–1380. doi: 10.1053/j.gastro.2018.12.005
Type
Article
ISSN
1528-0012
Source
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0016508518354027
DOI
10.1053/j.gastro.2018.12.005
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41843
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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