Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide
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...
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| Veröffentlicht in: | Gastroenterology (New York, N.Y. 1943) N.Y. 1943), 2019-04, Vol.156 (5), p.1368-1380.e10 |
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| creator | Piano, Salvatore Singh, Virendra Caraceni, Paolo Maiwall, Rakhi Alessandria, Carlo Fernandez, Javier Soares, Elza Cotrim Kim, Dong Joon Kim, Sung Eun Marino, Monica Vorobioff, Julio Barea, Rita de Cassia Ribeiro Merli, Manuela Elkrief, Laure Vargas, Victor Krag, Aleksander Singh, Shivaram Prasad Lesmana, Laurentius Adrianto Toledo, Claudio Marciano, Sebastian Verhelst, Xavier Wong, Florence Intagliata, Nicolas Rabinowich, Liane Colombato, Luis Kim, Sang Gyune Gerbes, Alexander Durand, Francois Roblero, Juan Pablo Bhamidimarri, Kalyan Ram Boyer, Thomas D. Maevskaya, Marina Fassio, Eduardo Kim, Hyoung Su Hwang, Jae Seok Gines, Pere Gadano, Adrian Sarin, Shiv Kumar Angeli, Paolo Bartoletti, Michele Brodersen, Carlos Bruns, Tony de Man, Robert A. Fialla, Annette Dam Gambino, Carmine Gautam, Vikas Girala, Marcos Juanola, Adria Kim, Jeong Han Kim, Tae Hun Kumar, Pramod Lattanzi, Barbara Lee, Tae Hee Rinaldi Lesmana, Cosmas A. Moreau, Richard Nath, Preetam Navarro, Gustavo Park, Ji-Won Pinero, Gisela Pyrsopoulos, Nikolaos T. Restellini, Sophie Romero, Gustavo Sacco, Marco Sevá-Pereira, Tiago Simón-Talero, Macarena Song, Do Seon Suk, Ki Tae Van Vlierberghe, Hans Yim, Sun Young Yoon, Eileen Laurel Zaccherini, Giacomo |
| description | 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.
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.
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.
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.
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| doi_str_mv | 10.1053/j.gastro.2018.12.005 |
| format | Article |
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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.
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.
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.
[Display omitted]</description><identifier>ISSN: 0016-5085</identifier><identifier>EISSN: 1528-0012</identifier><identifier>DOI: 10.1053/j.gastro.2018.12.005</identifier><identifier>PMID: 30552895</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Global ; Resistance ; Sepsis ; Stewardship</subject><ispartof>Gastroenterology (New York, N.Y. 1943), 2019-04, Vol.156 (5), p.1368-1380.e10</ispartof><rights>2019 AGA Institute</rights><rights>Copyright © 2019 AGA Institute. Published by Elsevier Inc. 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Young</creatorcontrib><creatorcontrib>Yoon, Eileen Laurel</creatorcontrib><creatorcontrib>Zaccherini, Giacomo</creatorcontrib><creatorcontrib>International Club of Ascites Global Study Group</creatorcontrib><title>Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide</title><title>Gastroenterology (New York, N.Y. 1943)</title><addtitle>Gastroenterology</addtitle><description>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.
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.
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.
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.
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Cirrhosis Worldwide</title><author>Piano, Salvatore ; Singh, Virendra ; Caraceni, Paolo ; Maiwall, Rakhi ; Alessandria, Carlo ; Fernandez, Javier ; Soares, Elza Cotrim ; Kim, Dong Joon ; Kim, Sung Eun ; Marino, Monica ; Vorobioff, Julio ; Barea, Rita de Cassia Ribeiro ; Merli, Manuela ; Elkrief, Laure ; Vargas, Victor ; Krag, Aleksander ; Singh, Shivaram Prasad ; Lesmana, Laurentius Adrianto ; Toledo, Claudio ; Marciano, Sebastian ; Verhelst, Xavier ; Wong, Florence ; Intagliata, Nicolas ; Rabinowich, Liane ; Colombato, Luis ; Kim, Sang Gyune ; Gerbes, Alexander ; Durand, Francois ; Roblero, Juan Pablo ; Bhamidimarri, Kalyan Ram ; Boyer, Thomas D. ; Maevskaya, Marina ; Fassio, Eduardo ; Kim, Hyoung Su ; Hwang, Jae Seok ; Gines, Pere ; Gadano, Adrian ; Sarin, Shiv Kumar ; Angeli, Paolo ; Bartoletti, Michele ; Brodersen, Carlos ; Bruns, Tony ; de Man, Robert A. ; Fialla, Annette Dam ; Gambino, Carmine ; Gautam, Vikas ; Girala, Marcos ; Juanola, Adria ; Kim, Jeong Han ; Kim, Tae Hun ; Kumar, Pramod ; Lattanzi, Barbara ; Lee, Tae Hee ; Rinaldi Lesmana, Cosmas A. ; Moreau, Richard ; Nath, Preetam ; Navarro, Gustavo ; Park, Ji-Won ; Pinero, Gisela ; Pyrsopoulos, Nikolaos T. ; Restellini, Sophie ; Romero, Gustavo ; Sacco, Marco ; Sevá-Pereira, Tiago ; Simón-Talero, Macarena ; Song, Do Seon ; Suk, Ki Tae ; Van Vlierberghe, Hans ; Yim, Sun Young ; Yoon, Eileen Laurel ; Zaccherini, Giacomo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-f4e54d4ddd9950be018cdbd9c7f08120827ef82f983121e56cc9ab46b9e7d2f13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Global</topic><topic>Resistance</topic><topic>Sepsis</topic><topic>Stewardship</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Piano, Salvatore</creatorcontrib><creatorcontrib>Singh, Virendra</creatorcontrib><creatorcontrib>Caraceni, Paolo</creatorcontrib><creatorcontrib>Maiwall, Rakhi</creatorcontrib><creatorcontrib>Alessandria, Carlo</creatorcontrib><creatorcontrib>Fernandez, Javier</creatorcontrib><creatorcontrib>Soares, Elza Cotrim</creatorcontrib><creatorcontrib>Kim, Dong Joon</creatorcontrib><creatorcontrib>Kim, Sung Eun</creatorcontrib><creatorcontrib>Marino, Monica</creatorcontrib><creatorcontrib>Vorobioff, Julio</creatorcontrib><creatorcontrib>Barea, Rita de Cassia Ribeiro</creatorcontrib><creatorcontrib>Merli, Manuela</creatorcontrib><creatorcontrib>Elkrief, Laure</creatorcontrib><creatorcontrib>Vargas, Victor</creatorcontrib><creatorcontrib>Krag, Aleksander</creatorcontrib><creatorcontrib>Singh, Shivaram Prasad</creatorcontrib><creatorcontrib>Lesmana, Laurentius Adrianto</creatorcontrib><creatorcontrib>Toledo, Claudio</creatorcontrib><creatorcontrib>Marciano, Sebastian</creatorcontrib><creatorcontrib>Verhelst, Xavier</creatorcontrib><creatorcontrib>Wong, Florence</creatorcontrib><creatorcontrib>Intagliata, Nicolas</creatorcontrib><creatorcontrib>Rabinowich, Liane</creatorcontrib><creatorcontrib>Colombato, Luis</creatorcontrib><creatorcontrib>Kim, Sang Gyune</creatorcontrib><creatorcontrib>Gerbes, Alexander</creatorcontrib><creatorcontrib>Durand, Francois</creatorcontrib><creatorcontrib>Roblero, Juan Pablo</creatorcontrib><creatorcontrib>Bhamidimarri, Kalyan Ram</creatorcontrib><creatorcontrib>Boyer, Thomas D.</creatorcontrib><creatorcontrib>Maevskaya, Marina</creatorcontrib><creatorcontrib>Fassio, Eduardo</creatorcontrib><creatorcontrib>Kim, Hyoung Su</creatorcontrib><creatorcontrib>Hwang, Jae Seok</creatorcontrib><creatorcontrib>Gines, Pere</creatorcontrib><creatorcontrib>Gadano, Adrian</creatorcontrib><creatorcontrib>Sarin, Shiv Kumar</creatorcontrib><creatorcontrib>Angeli, Paolo</creatorcontrib><creatorcontrib>Bartoletti, Michele</creatorcontrib><creatorcontrib>Brodersen, Carlos</creatorcontrib><creatorcontrib>Bruns, Tony</creatorcontrib><creatorcontrib>de Man, Robert A.</creatorcontrib><creatorcontrib>Fialla, Annette Dam</creatorcontrib><creatorcontrib>Gambino, Carmine</creatorcontrib><creatorcontrib>Gautam, Vikas</creatorcontrib><creatorcontrib>Girala, Marcos</creatorcontrib><creatorcontrib>Juanola, Adria</creatorcontrib><creatorcontrib>Kim, Jeong Han</creatorcontrib><creatorcontrib>Kim, Tae Hun</creatorcontrib><creatorcontrib>Kumar, Pramod</creatorcontrib><creatorcontrib>Lattanzi, Barbara</creatorcontrib><creatorcontrib>Lee, Tae Hee</creatorcontrib><creatorcontrib>Rinaldi Lesmana, Cosmas A.</creatorcontrib><creatorcontrib>Moreau, Richard</creatorcontrib><creatorcontrib>Nath, Preetam</creatorcontrib><creatorcontrib>Navarro, Gustavo</creatorcontrib><creatorcontrib>Park, Ji-Won</creatorcontrib><creatorcontrib>Pinero, Gisela</creatorcontrib><creatorcontrib>Pyrsopoulos, Nikolaos T.</creatorcontrib><creatorcontrib>Restellini, Sophie</creatorcontrib><creatorcontrib>Romero, Gustavo</creatorcontrib><creatorcontrib>Sacco, Marco</creatorcontrib><creatorcontrib>Sevá-Pereira, Tiago</creatorcontrib><creatorcontrib>Simón-Talero, Macarena</creatorcontrib><creatorcontrib>Song, Do Seon</creatorcontrib><creatorcontrib>Suk, Ki Tae</creatorcontrib><creatorcontrib>Van Vlierberghe, Hans</creatorcontrib><creatorcontrib>Yim, Sun Young</creatorcontrib><creatorcontrib>Yoon, Eileen Laurel</creatorcontrib><creatorcontrib>Zaccherini, Giacomo</creatorcontrib><creatorcontrib>International Club of Ascites Global Study Group</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastroenterology (New York, N.Y. 1943)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Piano, Salvatore</au><au>Singh, Virendra</au><au>Caraceni, Paolo</au><au>Maiwall, Rakhi</au><au>Alessandria, Carlo</au><au>Fernandez, Javier</au><au>Soares, Elza Cotrim</au><au>Kim, Dong Joon</au><au>Kim, Sung Eun</au><au>Marino, Monica</au><au>Vorobioff, Julio</au><au>Barea, Rita de Cassia Ribeiro</au><au>Merli, Manuela</au><au>Elkrief, Laure</au><au>Vargas, Victor</au><au>Krag, Aleksander</au><au>Singh, Shivaram Prasad</au><au>Lesmana, Laurentius Adrianto</au><au>Toledo, Claudio</au><au>Marciano, Sebastian</au><au>Verhelst, Xavier</au><au>Wong, Florence</au><au>Intagliata, Nicolas</au><au>Rabinowich, Liane</au><au>Colombato, Luis</au><au>Kim, Sang Gyune</au><au>Gerbes, Alexander</au><au>Durand, Francois</au><au>Roblero, Juan Pablo</au><au>Bhamidimarri, Kalyan Ram</au><au>Boyer, Thomas D.</au><au>Maevskaya, Marina</au><au>Fassio, Eduardo</au><au>Kim, Hyoung Su</au><au>Hwang, Jae Seok</au><au>Gines, Pere</au><au>Gadano, Adrian</au><au>Sarin, Shiv Kumar</au><au>Angeli, Paolo</au><au>Bartoletti, Michele</au><au>Brodersen, Carlos</au><au>Bruns, Tony</au><au>de Man, Robert A.</au><au>Fialla, Annette Dam</au><au>Gambino, Carmine</au><au>Gautam, Vikas</au><au>Girala, Marcos</au><au>Juanola, Adria</au><au>Kim, Jeong Han</au><au>Kim, Tae Hun</au><au>Kumar, Pramod</au><au>Lattanzi, Barbara</au><au>Lee, Tae Hee</au><au>Rinaldi Lesmana, Cosmas A.</au><au>Moreau, Richard</au><au>Nath, Preetam</au><au>Navarro, Gustavo</au><au>Park, Ji-Won</au><au>Pinero, Gisela</au><au>Pyrsopoulos, Nikolaos T.</au><au>Restellini, Sophie</au><au>Romero, Gustavo</au><au>Sacco, Marco</au><au>Sevá-Pereira, Tiago</au><au>Simón-Talero, Macarena</au><au>Song, Do Seon</au><au>Suk, Ki Tae</au><au>Van Vlierberghe, Hans</au><au>Yim, Sun Young</au><au>Yoon, Eileen Laurel</au><au>Zaccherini, Giacomo</au><aucorp>International Club of Ascites Global Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide</atitle><jtitle>Gastroenterology (New York, N.Y. 1943)</jtitle><addtitle>Gastroenterology</addtitle><date>2019-04</date><risdate>2019</risdate><volume>156</volume><issue>5</issue><spage>1368</spage><epage>1380.e10</epage><pages>1368-1380.e10</pages><issn>0016-5085</issn><eissn>1528-0012</eissn><abstract>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.
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.
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.
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.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30552895</pmid><doi>10.1053/j.gastro.2018.12.005</doi><orcidid>https://orcid.org/0000-0001-6236-780X</orcidid><orcidid>https://orcid.org/0000-0003-3173-9767</orcidid><orcidid>https://orcid.org/0000-0002-9598-4932</orcidid><orcidid>https://orcid.org/0000-0002-9092-464X</orcidid><orcidid>https://orcid.org/0000-0002-7190-6948</orcidid><orcidid>https://orcid.org/0000-0003-4657-4504</orcidid><orcidid>https://orcid.org/0000-0002-7983-1450</orcidid><orcidid>https://orcid.org/0000-0002-8197-2674</orcidid><orcidid>https://orcid.org/0000-0001-8694-777X</orcidid><orcidid>https://orcid.org/0000-0001-7859-6842</orcidid><orcidid>https://orcid.org/0000-0002-5622-0489</orcidid><orcidid>https://orcid.org/0000-0002-2798-5415</orcidid><orcidid>https://orcid.org/0000-0002-9356-5830</orcidid><orcidid>https://orcid.org/0000-0001-9263-8869</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0016-5085 |
| ispartof | Gastroenterology (New York, N.Y. 1943), 2019-04, Vol.156 (5), p.1368-1380.e10 |
| issn | 0016-5085 1528-0012 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2157676094 |
| source | Elsevier ScienceDirect Journals; Alma/SFX Local Collection |
| subjects | Global Resistance Sepsis Stewardship |
| title | Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-03T10%3A08%3A29IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Epidemiology%20and%20Effects%20of%20Bacterial%20Infections%20in%20Patients%20With%20Cirrhosis%20Worldwide&rft.jtitle=Gastroenterology%20(New%20York,%20N.Y.%201943)&rft.au=Piano,%20Salvatore&rft.aucorp=International%20Club%20of%20Ascites%20Global%20Study%20Group&rft.date=2019-04&rft.volume=156&rft.issue=5&rft.spage=1368&rft.epage=1380.e10&rft.pages=1368-1380.e10&rft.issn=0016-5085&rft.eissn=1528-0012&rft_id=info:doi/10.1053/j.gastro.2018.12.005&rft_dat=%3Cproquest_cross%3E2157676094%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2157676094&rft_id=info:pmid/30552895&rft_els_id=S0016508518354027&rfr_iscdi=true |