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VRE in cirrhotic patients

BACKGROUND: Vancomycin resistant enterococci (VRE) infections are of increasing concern in many hospitalized patients. Patients with cirrhosis are at added risk of infection with VRE, with associated increased risk for complications from infections. The goals of this study were to: [1] identify risk...

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Autores principales: Barger, Melissa, Blodget, Emily, Pena, Sol, Mack, Wendy, Fong, Tse-Ling
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693083/
https://www.ncbi.nlm.nih.gov/pubmed/31409282
http://dx.doi.org/10.1186/s12879-019-4352-1
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author Barger, Melissa
Blodget, Emily
Pena, Sol
Mack, Wendy
Fong, Tse-Ling
author_facet Barger, Melissa
Blodget, Emily
Pena, Sol
Mack, Wendy
Fong, Tse-Ling
author_sort Barger, Melissa
collection PubMed
description BACKGROUND: Vancomycin resistant enterococci (VRE) infections are of increasing concern in many hospitalized patients. Patients with cirrhosis are at added risk of infection with VRE, with associated increased risk for complications from infections. The goals of this study were to: [1] identify risk factors for VRE amongst cirrhotic patients before liver transplantation, and [2] evaluate risk of morbidity and mortality at 30-days and one-year after VRE infection. METHODS: Chart review of 533 cirrhotic patients hospitalized at a tertiary medical center was performed. Patients infected with VRE (n = 65) were separately compared to patients infected with gram-negative organisms (n = 80) and uninfected patients (n = 306). RESULTS: In multivariable logistic regression analyses, female gender (OR 3.73(95% CI1.64,8.49)), severity of liver disease measured by higher Child Pugh scores (OR 0.37(95%CI 0.16,0.84)), presence of ascites (OR 9.43(95% CI 3.22,27.65) and any type of dialysis (OR 3.31,95% CI (1.21,9.04), oral antibiotic prophylaxis for spontaneous bacterial peritonitis and rifaximin use were statistically significantly associated with VRE infection (OR 2.37 (95%CI 1.27, 4.42)). VRE-infected patients had significantly longer mean ICU and total hospital stays (both p < 0.0001), with increased one-year mortality compared to cirrhotic patients without VRE infection, adjusted for age, sex, Hispanic ethnicity, and disease severity. CONCLUSIONS: It is unclear whether VRE infection serves as an independent risk factor for increased mortality or an indicator for patients with more severe illnesses and thus a higher risk for death.
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spelling pubmed-66930832019-08-16 VRE in cirrhotic patients Barger, Melissa Blodget, Emily Pena, Sol Mack, Wendy Fong, Tse-Ling BMC Infect Dis Research Article BACKGROUND: Vancomycin resistant enterococci (VRE) infections are of increasing concern in many hospitalized patients. Patients with cirrhosis are at added risk of infection with VRE, with associated increased risk for complications from infections. The goals of this study were to: [1] identify risk factors for VRE amongst cirrhotic patients before liver transplantation, and [2] evaluate risk of morbidity and mortality at 30-days and one-year after VRE infection. METHODS: Chart review of 533 cirrhotic patients hospitalized at a tertiary medical center was performed. Patients infected with VRE (n = 65) were separately compared to patients infected with gram-negative organisms (n = 80) and uninfected patients (n = 306). RESULTS: In multivariable logistic regression analyses, female gender (OR 3.73(95% CI1.64,8.49)), severity of liver disease measured by higher Child Pugh scores (OR 0.37(95%CI 0.16,0.84)), presence of ascites (OR 9.43(95% CI 3.22,27.65) and any type of dialysis (OR 3.31,95% CI (1.21,9.04), oral antibiotic prophylaxis for spontaneous bacterial peritonitis and rifaximin use were statistically significantly associated with VRE infection (OR 2.37 (95%CI 1.27, 4.42)). VRE-infected patients had significantly longer mean ICU and total hospital stays (both p < 0.0001), with increased one-year mortality compared to cirrhotic patients without VRE infection, adjusted for age, sex, Hispanic ethnicity, and disease severity. CONCLUSIONS: It is unclear whether VRE infection serves as an independent risk factor for increased mortality or an indicator for patients with more severe illnesses and thus a higher risk for death. BioMed Central 2019-08-13 /pmc/articles/PMC6693083/ /pubmed/31409282 http://dx.doi.org/10.1186/s12879-019-4352-1 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Barger, Melissa
Blodget, Emily
Pena, Sol
Mack, Wendy
Fong, Tse-Ling
VRE in cirrhotic patients
title VRE in cirrhotic patients
title_full VRE in cirrhotic patients
title_fullStr VRE in cirrhotic patients
title_full_unstemmed VRE in cirrhotic patients
title_short VRE in cirrhotic patients
title_sort vre in cirrhotic patients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693083/
https://www.ncbi.nlm.nih.gov/pubmed/31409282
http://dx.doi.org/10.1186/s12879-019-4352-1
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