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The Spread of Multi Drug Resistant Infections Is Leading to an Increase in the Empirical Antibiotic Treatment Failure in Cirrhosis: A Prospective Survey

BACKGROUND: The spread of multi-resistant infections represents a continuously growing problem in cirrhosis, particularly in patients in contact with the healthcare environment. AIM: Our prospective study aimed to analyze epidemiology, prevalence and risk factors of multi-resistant infections, as we...

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Autores principales: Merli, Manuela, Lucidi, Cristina, Di Gregorio, Vincenza, Falcone, Marco, Giannelli, Valerio, Lattanzi, Barbara, Giusto, Michela, Ceccarelli, Giancarlo, Farcomeni, Alessio, Riggio, Oliviero, Venditti, Mario
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440761/
https://www.ncbi.nlm.nih.gov/pubmed/25996499
http://dx.doi.org/10.1371/journal.pone.0127448
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author Merli, Manuela
Lucidi, Cristina
Di Gregorio, Vincenza
Falcone, Marco
Giannelli, Valerio
Lattanzi, Barbara
Giusto, Michela
Ceccarelli, Giancarlo
Farcomeni, Alessio
Riggio, Oliviero
Venditti, Mario
author_facet Merli, Manuela
Lucidi, Cristina
Di Gregorio, Vincenza
Falcone, Marco
Giannelli, Valerio
Lattanzi, Barbara
Giusto, Michela
Ceccarelli, Giancarlo
Farcomeni, Alessio
Riggio, Oliviero
Venditti, Mario
author_sort Merli, Manuela
collection PubMed
description BACKGROUND: The spread of multi-resistant infections represents a continuously growing problem in cirrhosis, particularly in patients in contact with the healthcare environment. AIM: Our prospective study aimed to analyze epidemiology, prevalence and risk factors of multi-resistant infections, as well as the rate of failure of empirical antibiotic therapy in cirrhotic patients. METHODS: All consecutive cirrhotic patients hospitalized between 2008 and 2013 with a microbiologically-documented infection (MDI) were enrolled. Infections were classified as Community-Acquired (CA), Hospital-Acquired (HA) and Healthcare-Associated (HCA). Bacteria were classified as Multidrug-Resistant (MDR) if resistant to at least three antimicrobial classes, Extensively-Drug-Resistant (XDR) if only sensitive to one/two classes and Pandrug-Resistant (PDR) if resistant to all classes. RESULTS: One-hundred-twenty-four infections (15% CA, 52% HA, 33% HCA) were observed in 111 patients. Urinary tract infections, pneumonia and spontaneous bacterial peritonitis were the more frequent. Forty-seven percent of infections were caused by Gram-negative bacteria. Fifty-one percent of the isolates were multi-resistant to antibiotic therapy (76% MDR, 21% XDR, 3% PDR): the use of antibiotic prophylaxis (OR = 8.4; 95%CI = 1.03-76; P = 0,05) and current/recent contact with the healthcare-system (OR = 3.7; 95%CI = 1.05-13; P = 0.04) were selected as independent predictors. The failure of the empirical antibiotic therapy was progressively more frequent according to the degree of resistance. The therapy was inappropriate in the majority of HA and HCA infections. CONCLUSIONS: Multi-resistant infections are increasing in hospitalized cirrhotic patients. A better knowledge of the epidemiological characteristics is important to improve the efficacy of empirical antibiotic therapy. The use of preventive measures aimed at reducing the spread of multi-resistant bacteria is also essential.
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spelling pubmed-44407612015-05-29 The Spread of Multi Drug Resistant Infections Is Leading to an Increase in the Empirical Antibiotic Treatment Failure in Cirrhosis: A Prospective Survey Merli, Manuela Lucidi, Cristina Di Gregorio, Vincenza Falcone, Marco Giannelli, Valerio Lattanzi, Barbara Giusto, Michela Ceccarelli, Giancarlo Farcomeni, Alessio Riggio, Oliviero Venditti, Mario PLoS One Research Article BACKGROUND: The spread of multi-resistant infections represents a continuously growing problem in cirrhosis, particularly in patients in contact with the healthcare environment. AIM: Our prospective study aimed to analyze epidemiology, prevalence and risk factors of multi-resistant infections, as well as the rate of failure of empirical antibiotic therapy in cirrhotic patients. METHODS: All consecutive cirrhotic patients hospitalized between 2008 and 2013 with a microbiologically-documented infection (MDI) were enrolled. Infections were classified as Community-Acquired (CA), Hospital-Acquired (HA) and Healthcare-Associated (HCA). Bacteria were classified as Multidrug-Resistant (MDR) if resistant to at least three antimicrobial classes, Extensively-Drug-Resistant (XDR) if only sensitive to one/two classes and Pandrug-Resistant (PDR) if resistant to all classes. RESULTS: One-hundred-twenty-four infections (15% CA, 52% HA, 33% HCA) were observed in 111 patients. Urinary tract infections, pneumonia and spontaneous bacterial peritonitis were the more frequent. Forty-seven percent of infections were caused by Gram-negative bacteria. Fifty-one percent of the isolates were multi-resistant to antibiotic therapy (76% MDR, 21% XDR, 3% PDR): the use of antibiotic prophylaxis (OR = 8.4; 95%CI = 1.03-76; P = 0,05) and current/recent contact with the healthcare-system (OR = 3.7; 95%CI = 1.05-13; P = 0.04) were selected as independent predictors. The failure of the empirical antibiotic therapy was progressively more frequent according to the degree of resistance. The therapy was inappropriate in the majority of HA and HCA infections. CONCLUSIONS: Multi-resistant infections are increasing in hospitalized cirrhotic patients. A better knowledge of the epidemiological characteristics is important to improve the efficacy of empirical antibiotic therapy. The use of preventive measures aimed at reducing the spread of multi-resistant bacteria is also essential. Public Library of Science 2015-05-21 /pmc/articles/PMC4440761/ /pubmed/25996499 http://dx.doi.org/10.1371/journal.pone.0127448 Text en © 2015 Merli et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Merli, Manuela
Lucidi, Cristina
Di Gregorio, Vincenza
Falcone, Marco
Giannelli, Valerio
Lattanzi, Barbara
Giusto, Michela
Ceccarelli, Giancarlo
Farcomeni, Alessio
Riggio, Oliviero
Venditti, Mario
The Spread of Multi Drug Resistant Infections Is Leading to an Increase in the Empirical Antibiotic Treatment Failure in Cirrhosis: A Prospective Survey
title The Spread of Multi Drug Resistant Infections Is Leading to an Increase in the Empirical Antibiotic Treatment Failure in Cirrhosis: A Prospective Survey
title_full The Spread of Multi Drug Resistant Infections Is Leading to an Increase in the Empirical Antibiotic Treatment Failure in Cirrhosis: A Prospective Survey
title_fullStr The Spread of Multi Drug Resistant Infections Is Leading to an Increase in the Empirical Antibiotic Treatment Failure in Cirrhosis: A Prospective Survey
title_full_unstemmed The Spread of Multi Drug Resistant Infections Is Leading to an Increase in the Empirical Antibiotic Treatment Failure in Cirrhosis: A Prospective Survey
title_short The Spread of Multi Drug Resistant Infections Is Leading to an Increase in the Empirical Antibiotic Treatment Failure in Cirrhosis: A Prospective Survey
title_sort spread of multi drug resistant infections is leading to an increase in the empirical antibiotic treatment failure in cirrhosis: a prospective survey
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440761/
https://www.ncbi.nlm.nih.gov/pubmed/25996499
http://dx.doi.org/10.1371/journal.pone.0127448
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