Clinical and microbiological features of infection in alcoholic hepatitis: an international cohort study
Background Previous studies have described the clinical impact of infection in alcoholic hepatitis (AH) but none have comprehensively explored the aetiopathogenesis of infection in this setting. We examined the causes, consequences and treatment of infection in a cohort of patients with AH. Methods...
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| Veröffentlicht in: | Journal of gastroenterology 2017-11, Vol.52 (11), p.1192-1200 |
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| creator | Parker, Richard Im, Gene Jones, Fiona Hernández, Onan Pérez Nahas, Jonathan Kumar, Aditi Wheatley, Daniel Sinha, Ashish Gonzalez-Reimers, Emilio Sanchez-Pérez, María Ghezzi, Antonella David, Miruna Delia Corbett, Christopher McCune, Anne Aithal, Guruprasad Padur Holt, Andrew Stewart, Stephen |
| description | Background
Previous studies have described the clinical impact of infection in alcoholic hepatitis (AH) but none have comprehensively explored the aetiopathogenesis of infection in this setting. We examined the causes, consequences and treatment of infection in a cohort of patients with AH.
Methods
We undertook a retrospective cohort study of patients with AH admitted between 2009 and 2014 to seven centres in Europe and the USA. Clinical and microbiological data were extracted from medical records. Survival was analysed with Kaplan–Meier analysis and Cox proportional hazards analysis to control the data for competing factors. Propensity score matching was used to examine the efficacy of prophylactic antibiotics administered in the absence of infection.
Results
We identified 404 patients with AH. Of these, 199 (49%) showed clinical or culture evidence of infection. Gut commensal bacteria, particularly
Escherichia coli
and
Enterobacter
species, were most commonly isolated in culture. Fungal infection was rarely seen. Cultured organisms and antibiotic resistance differed markedly between centres. Infection was an independent risk factor for death (hazard ratio for death at 90 days 2.33, 95% confidence interval 1.63–3.35,
p
|
| doi_str_mv | 10.1007/s00535-017-1336-z |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5666044</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A714583452</galeid><sourcerecordid>A714583452</sourcerecordid><originalsourceid>FETCH-LOGICAL-c561t-34429dd50cdb716295452fdb9040ffc9ff9af6bef0cf2b390648f2f00da9c5fd3</originalsourceid><addsrcrecordid>eNp1kV1rFDEUhoModq3-AG9kwOupJ18zEy-EsqgtFLzR65DJx27K7GRNMkL763vWrbUFJRcJ5zzvyzl5CXlL4YwC9B8KgOSyBdq3lPOuvX1GVlRgRSrGnpMVKCFaSntxQl6Vcg1AOcjhJTlhAx9Uz9mKbNdTnKM1U2Nm1-yizWmMaUqb37XgTV2yL00KTZyDtzWmGV-NmWzapinaZuv3psYay0d0wFb1eTYHDOUHJtem1MXdvCYvgpmKf3N_n5IfXz5_X1-0V9--Xq7Pr1orO1pbLgRTzkmwbuxpx5QUkgU3KhAQglUhKBO60QewgY1cQSeGwAKAM8rK4Pgp-XT03S_jzjvr55rNpPc57ky-0clE_bQzx63epF9adl0HQqDB-3uDnH4uvlR9nRbcaSqaKqkoU33P_lIbM3mNf5PQzO5isfq8p0IOHOdG6uwfFB7n8avT7EPE-hMBPQowh1KyDw-DU9CHzPUxc42Z60Pm-hY17x5v_KD4EzIC7AgUbM0bnx9t9F_XO0bquas</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1959129772</pqid></control><display><type>article</type><title>Clinical and microbiological features of infection in alcoholic hepatitis: an international cohort study</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Parker, Richard ; Im, Gene ; Jones, Fiona ; Hernández, Onan Pérez ; Nahas, Jonathan ; Kumar, Aditi ; Wheatley, Daniel ; Sinha, Ashish ; Gonzalez-Reimers, Emilio ; Sanchez-Pérez, María ; Ghezzi, Antonella ; David, Miruna Delia ; Corbett, Christopher ; McCune, Anne ; Aithal, Guruprasad Padur ; Holt, Andrew ; Stewart, Stephen</creator><creatorcontrib>Parker, Richard ; Im, Gene ; Jones, Fiona ; Hernández, Onan Pérez ; Nahas, Jonathan ; Kumar, Aditi ; Wheatley, Daniel ; Sinha, Ashish ; Gonzalez-Reimers, Emilio ; Sanchez-Pérez, María ; Ghezzi, Antonella ; David, Miruna Delia ; Corbett, Christopher ; McCune, Anne ; Aithal, Guruprasad Padur ; Holt, Andrew ; Stewart, Stephen</creatorcontrib><description>Background
Previous studies have described the clinical impact of infection in alcoholic hepatitis (AH) but none have comprehensively explored the aetiopathogenesis of infection in this setting. We examined the causes, consequences and treatment of infection in a cohort of patients with AH.
Methods
We undertook a retrospective cohort study of patients with AH admitted between 2009 and 2014 to seven centres in Europe and the USA. Clinical and microbiological data were extracted from medical records. Survival was analysed with Kaplan–Meier analysis and Cox proportional hazards analysis to control the data for competing factors. Propensity score matching was used to examine the efficacy of prophylactic antibiotics administered in the absence of infection.
Results
We identified 404 patients with AH. Of these, 199 (49%) showed clinical or culture evidence of infection. Gut commensal bacteria, particularly
Escherichia coli
and
Enterobacter
species, were most commonly isolated in culture. Fungal infection was rarely seen. Cultured organisms and antibiotic resistance differed markedly between centres. Infection was an independent risk factor for death (hazard ratio for death at 90 days 2.33, 95% confidence interval 1.63–3.35,
p
< 0.001). Initiation of antibiotic therapy on admission in the absence of infection did not reduce mortality or alter the incidence of subsequent infections. Corticosteroid use increased the incidence of infection but this did not impact on survival.
Conclusions
In this large real-world cohort of patients with AH, infection was common and was associated with reduced short-term survival. Gram-negative, gut commensal bacteria were the predominant infective organisms, consistent with increased translocation of gut bacteria in AH; however, the characteristics of infection differ between centres. Infection should be actively sought and treated, but we saw no benefits of prophylactic antibiotics.</description><identifier>ISSN: 0944-1174</identifier><identifier>EISSN: 1435-5922</identifier><identifier>DOI: 10.1007/s00535-017-1336-z</identifier><identifier>PMID: 28389732</identifier><language>eng</language><publisher>Tokyo: Springer Japan</publisher><subject>Abdominal Surgery ; Adrenal Cortex Hormones - administration & dosage ; Adrenal Cortex Hormones - adverse effects ; Anti-Bacterial Agents - therapeutic use ; Antibiotic Prophylaxis - methods ; Antibiotic resistance ; Antibiotics ; Bacteria ; Bacteria - isolation & purification ; Bacterial Infections - drug therapy ; Bacterial Infections - epidemiology ; Bacterial Infections - prevention & control ; Biliary Tract ; Care and treatment ; Cohort analysis ; Cohort Studies ; Colorectal Surgery ; Corticosteroids ; Drug resistance in microorganisms ; Drug Resistance, Bacterial ; Escherichia coli ; Europe ; Female ; Gastroenterology ; Health aspects ; Hepatitis ; Hepatitis, Alcoholic - microbiology ; Hepatitis, Alcoholic - mortality ; Hepatology ; Humans ; Incidence ; Infection ; Infections ; Kaplan-Meier Estimate ; Male ; Medical records ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Microbiology ; Microbiota (Symbiotic organisms) ; Middle Aged ; Mortality ; Mycoses ; Mycoses - epidemiology ; Original Article—Liver ; Original —Liver, Pancreas, and Biliary Tract ; Pancreas ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Surgical Oncology ; Survival ; United States</subject><ispartof>Journal of gastroenterology, 2017-11, Vol.52 (11), p.1192-1200</ispartof><rights>The Author(s) 2017</rights><rights>COPYRIGHT 2017 Springer</rights><rights>Journal of Gastroenterology is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c561t-34429dd50cdb716295452fdb9040ffc9ff9af6bef0cf2b390648f2f00da9c5fd3</citedby><cites>FETCH-LOGICAL-c561t-34429dd50cdb716295452fdb9040ffc9ff9af6bef0cf2b390648f2f00da9c5fd3</cites><orcidid>0000-0003-4888-8670</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00535-017-1336-z$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00535-017-1336-z$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28389732$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Parker, Richard</creatorcontrib><creatorcontrib>Im, Gene</creatorcontrib><creatorcontrib>Jones, Fiona</creatorcontrib><creatorcontrib>Hernández, Onan Pérez</creatorcontrib><creatorcontrib>Nahas, Jonathan</creatorcontrib><creatorcontrib>Kumar, Aditi</creatorcontrib><creatorcontrib>Wheatley, Daniel</creatorcontrib><creatorcontrib>Sinha, Ashish</creatorcontrib><creatorcontrib>Gonzalez-Reimers, Emilio</creatorcontrib><creatorcontrib>Sanchez-Pérez, María</creatorcontrib><creatorcontrib>Ghezzi, Antonella</creatorcontrib><creatorcontrib>David, Miruna Delia</creatorcontrib><creatorcontrib>Corbett, Christopher</creatorcontrib><creatorcontrib>McCune, Anne</creatorcontrib><creatorcontrib>Aithal, Guruprasad Padur</creatorcontrib><creatorcontrib>Holt, Andrew</creatorcontrib><creatorcontrib>Stewart, Stephen</creatorcontrib><title>Clinical and microbiological features of infection in alcoholic hepatitis: an international cohort study</title><title>Journal of gastroenterology</title><addtitle>J Gastroenterol</addtitle><addtitle>J Gastroenterol</addtitle><description>Background
Previous studies have described the clinical impact of infection in alcoholic hepatitis (AH) but none have comprehensively explored the aetiopathogenesis of infection in this setting. We examined the causes, consequences and treatment of infection in a cohort of patients with AH.
Methods
We undertook a retrospective cohort study of patients with AH admitted between 2009 and 2014 to seven centres in Europe and the USA. Clinical and microbiological data were extracted from medical records. Survival was analysed with Kaplan–Meier analysis and Cox proportional hazards analysis to control the data for competing factors. Propensity score matching was used to examine the efficacy of prophylactic antibiotics administered in the absence of infection.
Results
We identified 404 patients with AH. Of these, 199 (49%) showed clinical or culture evidence of infection. Gut commensal bacteria, particularly
Escherichia coli
and
Enterobacter
species, were most commonly isolated in culture. Fungal infection was rarely seen. Cultured organisms and antibiotic resistance differed markedly between centres. Infection was an independent risk factor for death (hazard ratio for death at 90 days 2.33, 95% confidence interval 1.63–3.35,
p
< 0.001). Initiation of antibiotic therapy on admission in the absence of infection did not reduce mortality or alter the incidence of subsequent infections. Corticosteroid use increased the incidence of infection but this did not impact on survival.
Conclusions
In this large real-world cohort of patients with AH, infection was common and was associated with reduced short-term survival. Gram-negative, gut commensal bacteria were the predominant infective organisms, consistent with increased translocation of gut bacteria in AH; however, the characteristics of infection differ between centres. Infection should be actively sought and treated, but we saw no benefits of prophylactic antibiotics.</description><subject>Abdominal Surgery</subject><subject>Adrenal Cortex Hormones - administration & dosage</subject><subject>Adrenal Cortex Hormones - adverse effects</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotic Prophylaxis - methods</subject><subject>Antibiotic resistance</subject><subject>Antibiotics</subject><subject>Bacteria</subject><subject>Bacteria - isolation & purification</subject><subject>Bacterial Infections - drug therapy</subject><subject>Bacterial Infections - epidemiology</subject><subject>Bacterial Infections - prevention & control</subject><subject>Biliary Tract</subject><subject>Care and treatment</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Colorectal Surgery</subject><subject>Corticosteroids</subject><subject>Drug resistance in microorganisms</subject><subject>Drug Resistance, Bacterial</subject><subject>Escherichia coli</subject><subject>Europe</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Health aspects</subject><subject>Hepatitis</subject><subject>Hepatitis, Alcoholic - microbiology</subject><subject>Hepatitis, Alcoholic - mortality</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infection</subject><subject>Infections</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical records</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Microbiology</subject><subject>Microbiota (Symbiotic organisms)</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Mycoses</subject><subject>Mycoses - epidemiology</subject><subject>Original Article—Liver</subject><subject>Original —Liver, Pancreas, and Biliary Tract</subject><subject>Pancreas</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgical Oncology</subject><subject>Survival</subject><subject>United States</subject><issn>0944-1174</issn><issn>1435-5922</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kV1rFDEUhoModq3-AG9kwOupJ18zEy-EsqgtFLzR65DJx27K7GRNMkL763vWrbUFJRcJ5zzvyzl5CXlL4YwC9B8KgOSyBdq3lPOuvX1GVlRgRSrGnpMVKCFaSntxQl6Vcg1AOcjhJTlhAx9Uz9mKbNdTnKM1U2Nm1-yizWmMaUqb37XgTV2yL00KTZyDtzWmGV-NmWzapinaZuv3psYay0d0wFb1eTYHDOUHJtem1MXdvCYvgpmKf3N_n5IfXz5_X1-0V9--Xq7Pr1orO1pbLgRTzkmwbuxpx5QUkgU3KhAQglUhKBO60QewgY1cQSeGwAKAM8rK4Pgp-XT03S_jzjvr55rNpPc57ky-0clE_bQzx63epF9adl0HQqDB-3uDnH4uvlR9nRbcaSqaKqkoU33P_lIbM3mNf5PQzO5isfq8p0IOHOdG6uwfFB7n8avT7EPE-hMBPQowh1KyDw-DU9CHzPUxc42Z60Pm-hY17x5v_KD4EzIC7AgUbM0bnx9t9F_XO0bquas</recordid><startdate>20171101</startdate><enddate>20171101</enddate><creator>Parker, Richard</creator><creator>Im, Gene</creator><creator>Jones, Fiona</creator><creator>Hernández, Onan Pérez</creator><creator>Nahas, Jonathan</creator><creator>Kumar, Aditi</creator><creator>Wheatley, Daniel</creator><creator>Sinha, Ashish</creator><creator>Gonzalez-Reimers, Emilio</creator><creator>Sanchez-Pérez, María</creator><creator>Ghezzi, Antonella</creator><creator>David, Miruna Delia</creator><creator>Corbett, Christopher</creator><creator>McCune, Anne</creator><creator>Aithal, Guruprasad Padur</creator><creator>Holt, Andrew</creator><creator>Stewart, Stephen</creator><general>Springer Japan</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4888-8670</orcidid></search><sort><creationdate>20171101</creationdate><title>Clinical and microbiological features of infection in alcoholic hepatitis: an international cohort study</title><author>Parker, Richard ; Im, Gene ; Jones, Fiona ; Hernández, Onan Pérez ; Nahas, Jonathan ; Kumar, Aditi ; Wheatley, Daniel ; Sinha, Ashish ; Gonzalez-Reimers, Emilio ; Sanchez-Pérez, María ; Ghezzi, Antonella ; David, Miruna Delia ; Corbett, Christopher ; McCune, Anne ; Aithal, Guruprasad Padur ; Holt, Andrew ; Stewart, Stephen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c561t-34429dd50cdb716295452fdb9040ffc9ff9af6bef0cf2b390648f2f00da9c5fd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abdominal Surgery</topic><topic>Adrenal Cortex Hormones - administration & dosage</topic><topic>Adrenal Cortex Hormones - adverse effects</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotic Prophylaxis - methods</topic><topic>Antibiotic resistance</topic><topic>Antibiotics</topic><topic>Bacteria</topic><topic>Bacteria - isolation & purification</topic><topic>Bacterial Infections - drug therapy</topic><topic>Bacterial Infections - epidemiology</topic><topic>Bacterial Infections - prevention & control</topic><topic>Biliary Tract</topic><topic>Care and treatment</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Colorectal Surgery</topic><topic>Corticosteroids</topic><topic>Drug resistance in microorganisms</topic><topic>Drug Resistance, Bacterial</topic><topic>Escherichia coli</topic><topic>Europe</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Health aspects</topic><topic>Hepatitis</topic><topic>Hepatitis, Alcoholic - microbiology</topic><topic>Hepatitis, Alcoholic - mortality</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infection</topic><topic>Infections</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical records</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Microbiology</topic><topic>Microbiota (Symbiotic organisms)</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Mycoses</topic><topic>Mycoses - epidemiology</topic><topic>Original Article—Liver</topic><topic>Original —Liver, Pancreas, and Biliary Tract</topic><topic>Pancreas</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgical Oncology</topic><topic>Survival</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Parker, Richard</creatorcontrib><creatorcontrib>Im, Gene</creatorcontrib><creatorcontrib>Jones, Fiona</creatorcontrib><creatorcontrib>Hernández, Onan Pérez</creatorcontrib><creatorcontrib>Nahas, Jonathan</creatorcontrib><creatorcontrib>Kumar, Aditi</creatorcontrib><creatorcontrib>Wheatley, Daniel</creatorcontrib><creatorcontrib>Sinha, Ashish</creatorcontrib><creatorcontrib>Gonzalez-Reimers, Emilio</creatorcontrib><creatorcontrib>Sanchez-Pérez, María</creatorcontrib><creatorcontrib>Ghezzi, Antonella</creatorcontrib><creatorcontrib>David, Miruna Delia</creatorcontrib><creatorcontrib>Corbett, Christopher</creatorcontrib><creatorcontrib>McCune, Anne</creatorcontrib><creatorcontrib>Aithal, Guruprasad Padur</creatorcontrib><creatorcontrib>Holt, Andrew</creatorcontrib><creatorcontrib>Stewart, Stephen</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Parker, Richard</au><au>Im, Gene</au><au>Jones, Fiona</au><au>Hernández, Onan Pérez</au><au>Nahas, Jonathan</au><au>Kumar, Aditi</au><au>Wheatley, Daniel</au><au>Sinha, Ashish</au><au>Gonzalez-Reimers, Emilio</au><au>Sanchez-Pérez, María</au><au>Ghezzi, Antonella</au><au>David, Miruna Delia</au><au>Corbett, Christopher</au><au>McCune, Anne</au><au>Aithal, Guruprasad Padur</au><au>Holt, Andrew</au><au>Stewart, Stephen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical and microbiological features of infection in alcoholic hepatitis: an international cohort study</atitle><jtitle>Journal of gastroenterology</jtitle><stitle>J Gastroenterol</stitle><addtitle>J Gastroenterol</addtitle><date>2017-11-01</date><risdate>2017</risdate><volume>52</volume><issue>11</issue><spage>1192</spage><epage>1200</epage><pages>1192-1200</pages><issn>0944-1174</issn><eissn>1435-5922</eissn><abstract>Background
Previous studies have described the clinical impact of infection in alcoholic hepatitis (AH) but none have comprehensively explored the aetiopathogenesis of infection in this setting. We examined the causes, consequences and treatment of infection in a cohort of patients with AH.
Methods
We undertook a retrospective cohort study of patients with AH admitted between 2009 and 2014 to seven centres in Europe and the USA. Clinical and microbiological data were extracted from medical records. Survival was analysed with Kaplan–Meier analysis and Cox proportional hazards analysis to control the data for competing factors. Propensity score matching was used to examine the efficacy of prophylactic antibiotics administered in the absence of infection.
Results
We identified 404 patients with AH. Of these, 199 (49%) showed clinical or culture evidence of infection. Gut commensal bacteria, particularly
Escherichia coli
and
Enterobacter
species, were most commonly isolated in culture. Fungal infection was rarely seen. Cultured organisms and antibiotic resistance differed markedly between centres. Infection was an independent risk factor for death (hazard ratio for death at 90 days 2.33, 95% confidence interval 1.63–3.35,
p
< 0.001). Initiation of antibiotic therapy on admission in the absence of infection did not reduce mortality or alter the incidence of subsequent infections. Corticosteroid use increased the incidence of infection but this did not impact on survival.
Conclusions
In this large real-world cohort of patients with AH, infection was common and was associated with reduced short-term survival. Gram-negative, gut commensal bacteria were the predominant infective organisms, consistent with increased translocation of gut bacteria in AH; however, the characteristics of infection differ between centres. Infection should be actively sought and treated, but we saw no benefits of prophylactic antibiotics.</abstract><cop>Tokyo</cop><pub>Springer Japan</pub><pmid>28389732</pmid><doi>10.1007/s00535-017-1336-z</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-4888-8670</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0944-1174 |
| ispartof | Journal of gastroenterology, 2017-11, Vol.52 (11), p.1192-1200 |
| issn | 0944-1174 1435-5922 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5666044 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Adrenal Cortex Hormones - administration & dosage Adrenal Cortex Hormones - adverse effects Anti-Bacterial Agents - therapeutic use Antibiotic Prophylaxis - methods Antibiotic resistance Antibiotics Bacteria Bacteria - isolation & purification Bacterial Infections - drug therapy Bacterial Infections - epidemiology Bacterial Infections - prevention & control Biliary Tract Care and treatment Cohort analysis Cohort Studies Colorectal Surgery Corticosteroids Drug resistance in microorganisms Drug Resistance, Bacterial Escherichia coli Europe Female Gastroenterology Health aspects Hepatitis Hepatitis, Alcoholic - microbiology Hepatitis, Alcoholic - mortality Hepatology Humans Incidence Infection Infections Kaplan-Meier Estimate Male Medical records Medical research Medicine Medicine & Public Health Medicine, Experimental Microbiology Microbiota (Symbiotic organisms) Middle Aged Mortality Mycoses Mycoses - epidemiology Original Article—Liver Original —Liver, Pancreas, and Biliary Tract Pancreas Proportional Hazards Models Retrospective Studies Risk Factors Surgical Oncology Survival United States |
| title | Clinical and microbiological features of infection in alcoholic hepatitis: an international cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-08T12%3A28%3A29IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Clinical%20and%20microbiological%20features%20of%20infection%20in%20alcoholic%20hepatitis:%20an%20international%20cohort%20study&rft.jtitle=Journal%20of%20gastroenterology&rft.au=Parker,%20Richard&rft.date=2017-11-01&rft.volume=52&rft.issue=11&rft.spage=1192&rft.epage=1200&rft.pages=1192-1200&rft.issn=0944-1174&rft.eissn=1435-5922&rft_id=info:doi/10.1007/s00535-017-1336-z&rft_dat=%3Cgale_pubme%3EA714583452%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1959129772&rft_id=info:pmid/28389732&rft_galeid=A714583452&rfr_iscdi=true |