Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide

Salvatore Piano; Virendra Singh; Paolo Caraceni; Rakhi Maiwall; Carlo Alessandria; Javier Fernandez; Elza Cotrim Soares; Dong Joon Kim; Sung Eun Kim; Monica Marino; Julio Vorobioff; Rita de Cassia Ribeiro Barea; Manuela Merli; Laure Elkrief; Victor Vargas; Aleksander Krag; Shivaram Prasad Singh; Laurentius Adrianto Lesmana; Claudio Toledo; Sebastian Marciano; Xavier Verhelst; Florence Wong; Nicolas Intagliata; Liane Rabinowich; Luis Colombato; Sang Gyune Kim; Alexander Gerbes; Francois Durand; Juan Pablo Roblero; Kalyan Ram Bhamidimarri; Thomas D. Boyer; Marina Maevskaya; Eduardo Fassio; Hyoung Su Kim; Jae Seok Hwang; Pere Gines; Adrian Gadano; Shiv Kumar Sarin; Paolo Angeli; Michele Bartoletti; Carlos Brodersen; Tony Bruns; Robert A. de Man; Annette Dam Fialla; Carmine Gambino; Vikas Gautam; Marcos Girala; Adria Juanola; Jeong Han Kim; Tae Hun Kim; Pramod Kumar; Barbara Lattanzi; Tae Hee Lee; Cosmas A. Rinaldi Lesmana; Richard Moreau; Preetam Nath; Gustavo Navarro; Ji Won Park; Gisela Pinero; Nikolaos T. Pyrsopoulos; Sophie Restellini; Gustavo Romero; Marco Sacco; Tiago Sevá-Pereira; Macarena Simón-Talero; Do Seon Song; Ki Tae Suk; Hans Van Vlierberghe; Sun Young Yim; Eileen Laurel Yoon; Giacomo Zaccherini

doi:10.1053/j.gastro.2018.12.005

Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide

Salvatore Piano, Virendra Singh, Paolo Caraceni, Rakhi Maiwall, Carlo Alessandria, Javier Fernandez, Elza Cotrim Soares, Dong Joon Kim, Sung Eun Kim, Monica Marino, Julio Vorobioff, Rita de Cassia Ribeiro Barea, Manuela Merli, Laure Elkrief, Victor Vargas, Aleksander Krag, Shivaram Prasad Singh, Laurentius Adrianto Lesmana, Claudio Toledo, Sebastian MarcianoXavier Verhelst, Florence Wong, Nicolas Intagliata, Liane Rabinowich, Luis Colombato, Sang Gyune Kim, Alexander Gerbes, Francois Durand, Juan Pablo Roblero, Kalyan Ram Bhamidimarri, Thomas D. Boyer, Marina Maevskaya, Eduardo Fassio, Hyoung Su Kim, Jae Seok Hwang, Pere Gines, Adrian Gadano, Shiv Kumar Sarin, Paolo Angeli, Michele Bartoletti, Carlos Brodersen, Tony Bruns, Robert A. de Man, Annette Dam Fialla, Carmine Gambino, Vikas Gautam, Marcos Girala, Adria Juanola, Jeong Han Kim, Tae Hun Kim, Pramod Kumar, Barbara Lattanzi, Tae Hee Lee, Cosmas A. Rinaldi Lesmana, Richard Moreau, Preetam Nath, Gustavo Navarro, Ji Won Park, Gisela Pinero, Nikolaos T. Pyrsopoulos, Sophie Restellini, Gustavo Romero, Marco Sacco, Tiago Sevá-Pereira, Macarena Simón-Talero, Do Seon Song, Ki Tae Suk, Hans Van Vlierberghe, Sun Young Yim, Eileen Laurel Yoon, Giacomo Zaccherini

Departamento de Medicina

Producción científica: Contribución a una revista › Artículo › Investigación

367 Citas (Scopus)

Resumen

© 2019 AGA Institute 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.

Idioma original	Inglés
Páginas (desde-hasta)	1368-1380.e10
Número de páginas	23
Publicación	Gastroenterology
Volumen	156
N.º	5
DOI	https://doi.org/10.1053/j.gastro.2018.12.005
Estado	Publicada - 1 abr 2019

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10.1053/j.gastro.2018.12.005

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Piano, S., Singh, V., Caraceni, P., Maiwall, R., Alessandria, C., Fernandez, J., Soares, E. C., Kim, D. J., Kim, S. E., Marino, M., Vorobioff, J., Barea, R. D. C. R., Merli, M., Elkrief, L., Vargas, V., Krag, A., Singh, S. P., Lesmana, L. A., Toledo, C., ... Zaccherini, G. (2019). Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide. Gastroenterology, 156(5), 1368-1380.e10. https://doi.org/10.1053/j.gastro.2018.12.005

@article{f4540b3fb6b24349947fed036643c1c1,

title = "Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide",

abstract = "{\textcopyright} 2019 AGA Institute 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.",

keywords = "Global, Resistance, Sepsis, Stewardship, MORTALITY, SURVIVAL, DIAGNOSIS, MANAGEMENT, RISK-FACTORS, PREVALENCE, SEPSIS, PERITONITIS, CHRONIC LIVER-FAILURE, HEALTH-CARE",

author = "Salvatore Piano and Virendra Singh and Paolo Caraceni and Rakhi Maiwall and Carlo Alessandria and Javier Fernandez and Soares, {Elza Cotrim} and Kim, {Dong Joon} and Kim, {Sung Eun} and Monica Marino and Julio Vorobioff and Barea, {Rita de Cassia Ribeiro} and Manuela Merli and Laure Elkrief and Victor Vargas and Aleksander Krag and Singh, {Shivaram Prasad} and Lesmana, {Laurentius Adrianto} and Claudio Toledo and Sebastian Marciano and Xavier Verhelst and Florence Wong and Nicolas Intagliata and Liane Rabinowich and Luis Colombato and Kim, {Sang Gyune} and Alexander Gerbes and Francois Durand and Roblero, {Juan Pablo} and Bhamidimarri, {Kalyan Ram} and Boyer, {Thomas D.} and Marina Maevskaya and Eduardo Fassio and Kim, {Hyoung Su} and Hwang, {Jae Seok} and Pere Gines and Adrian Gadano and Sarin, {Shiv Kumar} and Paolo Angeli and Michele Bartoletti and Carlos Brodersen and Tony Bruns and {de Man}, {Robert A.} and Fialla, {Annette Dam} and Carmine Gambino and Vikas Gautam and Marcos Girala and Adria Juanola and Kim, {Jeong Han} and Kim, {Tae Hun} and Pramod Kumar and Barbara Lattanzi and Lee, {Tae Hee} and {Rinaldi Lesmana}, {Cosmas A.} and Richard Moreau and Preetam Nath and Gustavo Navarro and Park, {Ji Won} and Gisela Pinero and Pyrsopoulos, {Nikolaos T.} and Sophie Restellini and Gustavo Romero and Marco Sacco and Tiago Sev{\'a}-Pereira and Macarena Sim{\'o}n-Talero and Song, {Do Seon} and Suk, {Ki Tae} and {Van Vlierberghe}, Hans and Yim, {Sun Young} and Yoon, {Eileen Laurel} and Giacomo Zaccherini",

year = "2019",

month = apr,

day = "1",

doi = "10.1053/j.gastro.2018.12.005",

language = "English",

volume = "156",

pages = "1368--1380.e10",

journal = "Gastroenterology",

issn = "0016-5085",

publisher = "W.B. Saunders Ltd",

number = "5",

}

Piano, S, Singh, V, Caraceni, P, Maiwall, R, Alessandria, C, Fernandez, J, Soares, EC, Kim, DJ, Kim, SE, Marino, M, Vorobioff, J, Barea, RDCR, Merli, M, Elkrief, L, Vargas, V, Krag, A, Singh, SP, Lesmana, LA, Toledo, C, Marciano, S, Verhelst, X, Wong, F, Intagliata, N, Rabinowich, L, Colombato, L, Kim, SG, Gerbes, A, Durand, F, Roblero, JP, Bhamidimarri, KR, Boyer, TD, Maevskaya, M, Fassio, E, Kim, HS, Hwang, JS, Gines, P, Gadano, A, Sarin, SK, Angeli, P, Bartoletti, M, Brodersen, C, Bruns, T, de Man, RA, Fialla, AD, Gambino, C, Gautam, V, Girala, M, Juanola, A, Kim, JH, Kim, TH, Kumar, P, Lattanzi, B, Lee, TH, Rinaldi Lesmana, CA, Moreau, R, Nath, P, Navarro, G, Park, JW, Pinero, G, Pyrsopoulos, NT, Restellini, S, Romero, G, Sacco, M, Sevá-Pereira, T, Simón-Talero, M, Song, DS, Suk, KT, Van Vlierberghe, H, Yim, SY, Yoon, EL & Zaccherini, G 2019, 'Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide', Gastroenterology, vol. 156, n.º 5, pp. 1368-1380.e10. https://doi.org/10.1053/j.gastro.2018.12.005

TY - JOUR

T1 - Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide

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

AU - Kumar, Pramod

AU - Lattanzi, Barbara

AU - Lee, Tae Hee

AU - Rinaldi Lesmana, Cosmas A.

AU - Moreau, Richard

AU - Nath, Preetam

AU - Navarro, Gustavo

AU - Park, Ji Won

AU - Pinero, Gisela

AU - Pyrsopoulos, Nikolaos T.

AU - Restellini, Sophie

AU - Romero, Gustavo

AU - Sacco, Marco

AU - Sevá-Pereira, Tiago

AU - Simón-Talero, Macarena

AU - Song, Do Seon

AU - Suk, Ki Tae

AU - Van Vlierberghe, Hans

AU - Yim, Sun Young

AU - Yoon, Eileen Laurel

AU - Zaccherini, Giacomo

PY - 2019/4/1

Y1 - 2019/4/1

N2 - © 2019 AGA Institute 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 - © 2019 AGA Institute 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

KW - MORTALITY

KW - SURVIVAL

KW - DIAGNOSIS

KW - MANAGEMENT

KW - RISK-FACTORS

KW - PREVALENCE

KW - SEPSIS

KW - PERITONITIS

KW - CHRONIC LIVER-FAILURE

KW - HEALTH-CARE

UR - http://www.mendeley.com/research/epidemiology-effects-bacterial-infections-patients-cirrhosis-worldwide

U2 - 10.1053/j.gastro.2018.12.005

DO - 10.1053/j.gastro.2018.12.005

M3 - Article

C2 - 30552895

SN - 0016-5085

VL - 156

SP - 1368-1380.e10

JO - Gastroenterology

JF - Gastroenterology

IS - 5

ER -

Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide

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