Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: A prospective study
Open accessAbstract
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 : Multiresistant bacteria, especially ESBL-producing Enterobacteriaceae , are frequently isolated in nosocomial and, to a lesser extent, HCA infections in cirrhosis, rendering third-generation cephalosporins clinically ineffective. New antibiotic strategies tailored according to the local epidemiological patterns are needed for the empirical treatment of nosocomial infections in cirrhosis. (Hepatology 2012)
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A major problem with norfloxacin is the development of antibiotic resistance.
“A major problem with the use of norfloxacin is the development of antibiotic resistance110–112, suggesting that it might be suitable for treatment lasting weeks to months but not for long-term or life-long application in patients with cirrhosis.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [111]
Norfloxacin may be suitable for weeks to months of treatment but not for long-term or life-long use in cirrhosis patients.
“A major problem with the use of norfloxacin is the development of antibiotic resistance110–112, suggesting that it might be suitable for treatment lasting weeks to months but not for long-term or life-long application in patients with cirrhosis.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [111]
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- Authors
- Fernández, J., Acevedo, J., Castro, M., Garcia, O., de Lope, C. R., Roca, D., Pavesi, M., Sola, E., Moreira, L., Silva, A., Seva-Pereira, T., Corradi, F., Mensa, J., Ginès, P., & Arroyo, V.
- Affiliations
- Hospital Clínic de Barcelona (ES)
- Corresponding author
- Fernández, Javier
- ORCID
- Venue
- Hepatology
- Published
- 2012-05
- Volume
- 55
- Issue
- 5
- Pages
- 1551-1561
- ISSN
- 0270-9139 (ISSN-L)
- OpenAlex
- W1989550571
- Cited by
- 620
- References
- 48
- Citations by year
- 2026: 20 · 2025: 25 · 2024: 33 · 2023: 45 · 2022: 52 · 2021: 49 · 2020: 38 · 2019: 58 · 2018: 66 · 2017: 53 · 2016: 42 · 2015: 53 · 2014: 43 · 2013: 29 · 2012: 13
- FWCI
- 17.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Funders
- Fundación BBVA
- Instituto de Salud Carlos III (FI09/00510)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- multidrug-resistant bacteria, liver cirrhosis, bacterial infection, nosocomial infections, community-acquired infections, extended-spectrum beta-lactamase, ESBL-producing Enterobacteriaceae, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, Enterococcus faecium, empirical antibiotic therapy, septic shock, mortality, risk factors, spontaneous bacterial peritonitis, pneumonia, urinary tract infection
- MeSH terms
- Aged, Bacterial Infections, beta-Lactamases, Cross Infection, Enterobacteriaceae, Female, Gram-Negative Bacteria, Gram-Positive Bacteria, Humans, Liver Cirrhosis, Male, Microbial Sensitivity Tests, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Spain, Cohort Studies, Prevalence, Multivariate Analysis, Proportional Hazards Models, Survival Analysis, Community-Acquired Infections, Statistics, Nonparametric, Drug Resistance, Multiple, Bacterial, Methicillin-Resistant Staphylococcus aureus
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