Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide

International Club of Ascites Global Study Group

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background & Aims: Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis. Methods: We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge. Results: The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%–37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival. Conclusions: In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.

Original languageEnglish (US)
Pages (from-to)1368-1380.e10
JournalGastroenterology
Volume156
Issue number5
DOIs
StatePublished - Apr 1 2019

Fingerprint

Bacterial Infections
Epidemiology
Fibrosis
Bacteria
Infection
Anti-Bacterial Agents
Mycoses
Hospitalization
South America
North America
Hospital Mortality
Microbiology
Liver Transplantation
India
Shock
Demography
Prospective Studies
Confidence Intervals
Delivery of Health Care
Survival

Keywords

  • Global
  • Resistance
  • Sepsis
  • Stewardship

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide. / International Club of Ascites Global Study Group.

In: Gastroenterology, Vol. 156, No. 5, 01.04.2019, p. 1368-1380.e10.

Research output: Contribution to journalArticle

International Club of Ascites Global Study Group 2019, 'Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide', Gastroenterology, vol. 156, no. 5, pp. 1368-1380.e10. https://doi.org/10.1053/j.gastro.2018.12.005
International Club of Ascites Global Study Group. / Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide. In: Gastroenterology. 2019 ; Vol. 156, No. 5. pp. 1368-1380.e10.
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T1 - Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide

AU - International Club of Ascites Global Study Group

AU - Piano, Salvatore

AU - Singh, Virendra

AU - Caraceni, Paolo

AU - Maiwall, Rakhi

AU - Alessandria, Carlo

AU - Fernandez, Javier

AU - Soares, Elza Cotrim

AU - Kim, Dong Joon

AU - Kim, Sung Eun

AU - Marino, Monica

AU - Vorobioff, Julio

AU - Barea, Rita de Cassia Ribeiro

AU - Merli, Manuela

AU - Elkrief, Laure

AU - Vargas, Victor

AU - Krag, Aleksander

AU - Singh, Shivaram Prasad

AU - Lesmana, Laurentius Adrianto

AU - Toledo, Claudio

AU - Marciano, Sebastian

AU - Verhelst, Xavier

AU - Wong, Florence

AU - Intagliata, Nicolas

AU - Rabinowich, Liane

AU - Colombato, Luis

AU - Kim, Sang Gyune

AU - Gerbes, Alexander

AU - Durand, Francois

AU - Roblero, Juan Pablo

AU - Bhamidimarri, Kalyan Ram

AU - Boyer, Thomas D

AU - Maevskaya, Marina

AU - Fassio, Eduardo

AU - Kim, Hyoung Su

AU - Hwang, Jae Seok

AU - Gines, Pere

AU - Gadano, Adrian

AU - Sarin, Shiv Kumar

AU - Angeli, Paolo

AU - Bartoletti, Michele

AU - Brodersen, Carlos

AU - Bruns, Tony

AU - de Man, Robert A.

AU - Fialla, Annette Dam

AU - Gambino, Carmine

AU - Gautam, Vikas

AU - Girala, Marcos

AU - Juanola, Adria

AU - Kim, Jeong Han

AU - Kim, Tae Hun

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background & Aims: Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis. Methods: We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge. Results: The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%–37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival. Conclusions: In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.

AB - Background & Aims: Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis. Methods: We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge. Results: The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%–37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival. Conclusions: In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.

KW - Global

KW - Resistance

KW - Sepsis

KW - Stewardship

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