Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide
- 주제(키워드) Global , Resistance , Sepsis , Stewardship
- 주제(기타) Gastroenterology & Hepatology
- 설명문(일반) [Piano, Salvatore; Angeli, Paolo; Gambino, Carmine] Univ Padua, Dept Med, Unit Internal Med & Hepatol, Via Giustiniani 2, I-35100 Padua, Italy; [Singh, Virendra; Kumar, Pramod] Postgrad Inst Med Educ & Res, Dept Hepatol, Chandigarh, India; [Caraceni, Paolo; Bartoletti, Michele; Zaccherini, Giacomo] Univ Bologna, Dept Med & Surg Sci, Bologna, Italy; [Maiwall, Rakhi; Sarin, Shiv Kumar] Inst Liver & Biliary Sci, New Delhi, India; [Alessandria, Carlo; Sacco, Marco] Univ Turin, Citta Salute & Sci Hosp, Div Gastroenterol & Hepatol, Turin, Italy; [Fernandez, Javier; Gines, Pere; Juanola, Adria] Univ Barcelona, Liver ICU, Liver Unit, Hosp Clin, Barcelona, Catalonia, Spain; [Fernandez, Javier; Gines, Pere] Inst Invest Biomed August Pi Sunyer, Barcelona, Catalonia, Spain; [Fernandez, Javier; Gines, Pere] Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Catalonia, Spain; [Fernandez, Javier] European Fdn Chron Liver Failure EF Clif, Barcelona, Catalonia, Spain; [Soares, Elza Cotrim; Seva-Pereira, Tiago] Univ Campinas UNICAMP, Div Gastroenterol, Dept Med, Fac Med Sci, Campinas, SP, Brazil; [Kim, Dong Joon; Suk, Ki Tae] Hallym Univ, Coll Med, Dept Internal Med, Chunchon, South Korea; [Kim, Sung Eun; Park, Ji-Won] Hallym Univ, Div Gastroenterol & Hepatol, Dept Internal Med, Hallym Sacred Heart Hosp,Coll Med, Anyang, South Korea; [Marino, Monica; Romero, Gustavo] Hosp Dr Carlos B Udaondo, Liver Unit, Buenos Aires, DF, Argentina; [Vorobioff, Julio; Pinero, Gisela] Rosario Univ, Sch Med, Rosario, Santa Fe, Argentina; [Ribeiro Barea, Rita de Cassia] Hosp Reg Mato Grosso Sul, Serv Hepatol, Campo Grande, Brazil; [Merli, Manuela; Lattanzi, Barbara] Sapienza Univ Rome, Gastroenterol & Hepatol Unit, Dept Clin Med, Rome, Italy; [Elkrief, Laure] Hop Univ Geneve, Serv Transplantat, Serv Hepatogastroenterol, Geneva, Switzerland; [Vargas, Victor] Univ Autonoma Barcelona, Dept Internal Med, Hosp Vall dHebron, Liver Unit,CIBERehd, Barcelona, Spain; [Krag, Aleksander; Fialla, Annette Dam] Odense Univ Hosp, Dept Gastroenterol & Hepatol, Odense, Denmark; [Singh, Shivaram Prasad; Nath, Preetam] SCB Med Coll, Dept Gastroenterol, Cuttack, Orissa, India; [Lesmana, Laurentius Adrianto; Lesmana, Cosmas A. Rinaldi] Medistra Hosp, Digest Dis & Oncol Ctr, Jakarta, Indonesia; [Toledo, Claudio; Navarro, Gustavo] Univ Austral Chile, Gastroenterol Unit, Hosp Valdivia, Valdivia, Chile; [Marciano, Sebastian; Gadano, Adrian] Hosp Italiano Buenos, Liver Unit, Buenos Aires, DF, Argentina; [Marciano, Sebastian; Gadano, Adrian] Hosp Italiano Buenos, Dept Res, Buenos Aires, DF, Argentina; [Verhelst, Xavier; Van Vlierberghe, Hans] Ghent Univ Hosp, Dept Gastroenterol & Hepatol, Ghent, Belgium; [Wong, Florence] Univ Toronto, Dept Med, Div Gastroenterol, Toronto, ON, Canada; [Intagliata, Nicolas] Univ Virginia, Div Gastroenterol & Hepatol, Charlottesville, VA USA; [Rabinowich, Liane] Tel Aviv Med Ctr & Sch Med, Dept Gastroenterol, Liver Unit, Tel Aviv, Israel; [Rabinowich, Liane] Tel Aviv Univ, Tel Aviv, Israel; [Colombato, Luis] Argentine Catholic Univ, Dept Gastroenterol, Buenos Aires British Hosp, Buenos Aires, DF, Argentina; [Kim, Sang Gyune] Soonchunhyang Univ, Bucheon Hosp, Dept Internal Med, Bucheon, South Korea; [Gerbes, Alexander] Ludwig Maximilians Univ Munchen, Univ Hosp, Dept Med 2, Liver Ctr Munich, Munich, Germany; [Durand, Francois] Hosp Beaujon, Hepatol & Liver Intens Care, Clichy, France; [Durand, Francois] Univ Paris Diderot, Paris, France; [Pablo Roblero, Juan] Univ Chile, Dept Med, Hosp Clin San Borja Arriaran, Campus Ctr, Santiago, Chile; [Bhamidimarri, Kalyan Ram] Univ Miami, Div Gastroenterol Hepatol, Miami, FL USA; [Boyer, Thomas D.] Univ Arizona, Dept Med, Tucson, AZ USA; [Maevskaya, Marina] Univ Moscow, Moscow, Russia; [Fassio, Eduardo] Hosp Nacl Prof Alejandro Posadas El Palomar, Liver Unit, Buenos Aires, DF, Argentina; [Kim, Hyoung Su] Hallym Univ, Kangdong Sacred Heart Hosp, Dept Internal Med, Seoul, South Korea; [Hwang, Jae Seok] Keimyung Univ, Sch Med, Dept Internal Med, Daegu, South Korea; [Brodersen, Carlos] Hosp Durand, Unidad Gastroenterol, Buenos Aires, DF, Argentina; [Bruns, Tony] Jena Univ Hosp, Dept Internal Med 4, Jena, Germany; [de Man, Robert A.] Erasmus MC Med Ctr, Dept Gastroenterol & Hepatol, Rotterdam, Netherlands; [Gautam, Vikas] Postgrad Inst Med Educ & Res, Chandigarh, India; [Girala, Marcos] Univ Nacl Asuncion, Dept Gastroenterol & Endoscopia Digest, Hosp Clin, Asuncion, Paraguay; [Kim, Jeong Han] Konkuk Univ, Med Ctr, Seoul, South Korea; [Kim, Tae Hun] Ewha Womans Univ, Sch Med, Dept Internal Med, Seoul, South Korea; [Lee, Tae Hee] Konyang Univ, Coll Med, Dept Internal Med, Daejeon, South Korea; [Moreau, Richard] Hop Beaujon, AP HP, Serv Hepatol, Clichy, France; [Pyrsopoulos, Nikolaos T.] Rutgers New Jersey Med Sch, Univ Hosp, Div Gastroenterol & Hepatol, Newark, NJ USA; [Restellini, Sophie] Hop Univ Geneve, Serv Hepatogastroenterol, Geneva, Switzerland; [Simon-Talero, Macarena] Hosp Valle De Hebron, Liver Unit, Dept Internal Med, Barcelona, Spain; [Song, Do Seon] Catholic Univ Korea, St Vincents Hosp, Suwon, South Korea; [Yim, Sun Young] Univ Korea Hosp, Dept Internal Med, Div Gastroenterol & Hepatol, Seoul, South Korea; [Yoon, Eileen Laurel] Inje Univ, Dept Internal Med, Sanggye Paik Hosp, Seoul, South Korea
- 등재 SCIE, SCOPUS
- OA유형 Bronze, Green Submitted
- 발행기관 W B SAUNDERS CO-ELSEVIER INC
- 발행년도 2019
- URI http://www.dcollection.net/handler/ewha/000000159997
- 본문언어 영어
- Published As http://dx.doi.org/10.1053/j.gastro.2018.12.005
- PubMed https://pubmed.ncbi.nlm.nih.gov/30552895
초록/요약
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.
more