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Inicio Gastroenterología y Hepatología (English Edition) Incidence, risk factors and clinical outcomes of multidrug-resistant microorgani...
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Vol. 46. Issue 4.
Pages 288-296 (April 2023)
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Vol. 46. Issue 4.
Pages 288-296 (April 2023)
Original article
Incidence, risk factors and clinical outcomes of multidrug-resistant microorganism infections among patients admitted for decompensated cirrhosis: A prospective study
Incidencia, factores de riesgo y evolución clínica de las infecciones por microorganismos multiresistentes en pacientes ingresados por descompensación de la cirrosis: estudio retrospectivo
Helena Masnoua,b,
Corresponding author
hmasnou.germanstrias@gencat.cat

Corresponding author.
, Ariadna Aguilara, Ignacio Iborraa, Margarita Salab,c, Maria Tornera, Ariadna Clos-Paralsa, Alba Ardèvola, Montserrat Giménezd, Marta Fortunya, Maria Rosa Sarriasb,e, Rosa M. Morillasa,b, Eugeni Domènecha,b
a Gastroenterology & Hepatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
b Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas, Spain
c Gastroenterology & Hepatology Department, Hospital Universitari Josep Trueta, Spain
d Microbiology Department, Clinical Laboratory Nord Metropolitan Area, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
e Innate Immunity Group, Health Research Institute Germans Trias i Pujol, Spain
Article information
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Figures (1)
Tables (4)
Table 1. Main characteristics of the patients at each infectious episode (N=139).
Table 2. Risk factors of MDRM.
Table 3. Risk factors for in-hospital infection-related mortality. Hepatocellular carcinoma with Milan-out criteria exclused (N=128).
Table 4. Risk factors for in-hospital infection-related mortality in infectious episodes in which the causative bacteria were identified and Hepatocellular carcinoma out of Milan criteria were excluded (N=85).
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Abstract
Background

Bacterial infections remain one of the main complications in cirrhosis and worsen patients’ prognosis and quality of life. An increase in multidrug resistant microorganism (MDRM) infections among patients with cirrhosis, together with infection-related mortality rates, have been reported in recent years. Therefore, adaptation of the initial empiric antibiotic approach to different factors, particularly the local epidemiology of MDRM infections, has been recommended. We aim to describe the main features, outcomes and risk factors of MDRM infections in patients with cirrhosis.

Methods

Prospective registry of all episodes of in-hospital infections occurring among cirrhotic patients admitted within a 2-year period at a single center. Clinical and microbiological data were collected at the time of infection diagnosis, and the in-hospital mortality rate of the infectious episode was registered.

Results

A total of 139 infectious episodes were included. The disease-causing microorganism was identified in 90 episodes (65%), of which 31 (22%) were caused by MDRM. The only two factors independently associated with MDRM infections were rectal colonization by MDRM and a nosocomial or healthcare-associated source. The infection-related mortality rate was 18.7%. MDRM infection and a past history of hepatic encephalopathy were independently associated with in-hospital mortality.

Conclusions

Almost one fourth of bacterial infections occurring in admitted cirrhotic patients were due to MDRM. Rectal colonization was the most important risk factor for MDRM infections in decompensated cirrhosis. Screening for MDRM rectal colonization in patients admitted for decompensated cirrhosis should be assessed as a tool to improve local empiric antibiotic strategies.

Keywords:
Multidrug-resistant microorganism
Cirrhosis
Infection
Mortality
Resumen
Antecedentes

Las infecciones bacterianas representan una de las principales complicaciones del paciente cirrótico, empeoran su pronóstico y calidad de vida. Recientemente se ha descrito un aumento de infecciones por microorganismos multiresistentes (MMR) en pacientes cirróticos, con un incremento de la mortalidad relacionada con la infección. Se recomienda adecuar el tratamiento antibiótico empírico inicial a diferentes factores, en particular a la epidemiología local. El objetivo del estudio es describir las principales características clínicas, evolución y factores de riesgo asociados a infecciones por MMR en cirrosis.

Métodos

Se registraron todos los episodios de infecciones bacterianas que presentaron los pacientes hospitalizados durante un período de 2 años en un único centro. Se recogieron datos clínicos y microbiológicos en el momento de la infección y la tasa de mortalidad intrahospitalaria.

Resultados

Se incluyó un total de 139 episodios de infección. Se identificó el microorganismo responsable de la infección en 90 episodios (65%), de los cuales en 31 (22%) la causa fue un MMR. Los 2 factores asociados independientemente con las infecciones MMR fueron colonización rectal por MMR y origen nosocomial o asociado al sistema sanitario de la infección. La mortalidad intrahospitalaria relacionada con la infección fue del 18,7%. La infección por MMR y tener antecedentes de encefalopatía hepática se asociaron independientemente con la mortalidad intrahospitalaria.

Conclusiones

Casi una cuarta parte de las infecciones que aparecen en los pacientes cirróticos hospitalizados son producidas por MMR. La colonización rectal fue el factor de riesgo más importante para infecciones por MMR. El cribado de colonización rectal por MMR en pacientes con cirrosis descompensada debe valorarse como una herramienta para mejorar las estrategias de terapia antibiótica empírica.

Palabras clave:
Microorganismos multiresistentes
Cirrhosis
Infección
Mortalidad

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