Epidemiology, risk factors, and clinical effect of
infections by multiresistant bacteria in
cirrhosis are poorly known. This work was a prospective evaluation in two series of cirrhotic patients admitted with
infection or developing
infection during hospitalization. The first series was studied between 2005 and 2007 (507
bacterial infections in 223 patients) and the second between 2010 and 2011 (162
bacterial infections in 110 patients). In the first series, 32% of
infections were community acquired (CA), 32% healthcare associated (HCA), and 36% nosocomial. Multiresistant bacteria (92
infections; 18%) were isolated in 4%, 14%, and 35% of these
infections, respectively (P < 0.001). Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E; n = 43) was the main multiresistant organism identified, followed by Pseudomonas aeruginosa (n = 17), methicillin-resistant Staphylococcus aureus (n = 14), and Enterococcus faecium (n = 14). The efficacy of currently recommended empirical
antibiotic therapy was very low in
nosocomial infections (40%), compared to HCA and CA episodes (73% and 83%, respectively; P < 0.0001), particularly in spontaneous bacterial
peritonitis,
urinary tract infection, and
pneumonia (26%, 29%, and 44%, respectively).
Septic shock (26% versus 10%; P < 0.0001) and mortality rate (25% versus 12%; P = 0.001) were significantly higher in
infections caused by multiresistant strains. Nosocomial origin of
infection (hazard ratio [HR], 4.43), long-term
norfloxacin prophylaxis (HR, 2.69), recent
infection by multiresistant bacteria (HR, 2.45), and recent use of β-
lactams (HR, 2.39) were independently associated with the development of multiresistant
infections. Results in the second series were similar to those observed in the first series.
CONCLUSIONS: