Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: A prospective study
Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: A prospective study
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DOI：
10.1002/hep.25532
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发表时间：
2012-05-01
期刊：
影响因子：
13.5
通讯作者：
Arroyo, Vicente
中科院分区：
文献类型：
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作者：
Fernandez, Javier;Acevedo, Juan;Arroyo, Vicente
肝硬变中多重耐药细菌感染的流行病学、危险因素和临床效果鲜为人知。这项工作是对两组在住院期间发生感染或发生感染的肝硬变患者进行的前瞻性评估。第一个系列是在2005年至2007年(223名患者中507名细菌感染)和2010年至2011年(110名患者中162名细菌感染)之间进行的研究。在第一个系列中，32%的感染是社区获得性感染(CA)，32%的感染与医疗保健相关(HCA)，36%的感染是医院感染。在这些感染中，分别有4%、14%和35%分离出多重耐药菌(92例感染；18%)(P<；0.001)。产超广谱β-内酰胺酶肠杆菌科细菌(ESBL-E；n=43)是主要的多重耐药菌，其次为铜绿假单胞菌(n=17)、耐甲氧西林金黄色葡萄球菌(n=14)和粪肠球菌(n=14)。目前推荐的经验性抗生素治疗在院内感染中的有效率(40%)非常低，相比于肝细胞癌和尖锐湿疣的发生率(分别为73%和83%；P<；0.0001)，特别是在自发性细菌性腹膜炎、尿路感染和肺炎方面(分别为26%、29%和44%)。在多重耐药菌株引起的感染中，感染性休克(26%比10%；P<；0.0001)和死亡率(25%比12%；P=0.001)显著更高。院内感染来源(危险比[HR]，4.43)、长期预防诺氟沙星(HR，2.69)、近期多重耐药菌感染(HR，2.45)和近期使用β-内酰胺类抗生素(HR，2.39)是多重耐药感染的独立相关因素。第二个系列的结果与第一个系列的观察结果相似。结论：多重耐药菌，尤其是产超广谱β-内酰胺酶的肠杆菌科细菌，在医院内经常被分离，在较小程度上，在肝硬变的HCA感染中被分离，导致第三代头孢菌素临床无效。需要根据当地流行病学模式量身定做新的抗生素策略，以进行肝硬化医院感染的经验性治疗。(2012国际肝病)
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 beta-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 beta-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)