Clinical Microbiology and Infection
Clinical Microbiology and Infection
5 years ago

A Prospective Multicentre Study of the Epidemiology and Outcomes of Bloodstream Infection in Cirrhotic Patients

The aim of this study was to describe the current epidemiology of BSI in patients with cirrhosis, analyse predictors of 30-day mortality, and risk factors for antibiotic resistance. Methods Cirrhotic patients developing a BSI episode were prospectively included at 19 centres in five countries from September 2014 to December 2015. The discrimination of mortality risk scores for 30-day mortality were compared by area under the receiver operator-risk and Cox-regression models. Risk factors for multidrug-resistant organisms (MDRO) were assessed with a logistic regression model. Results We enrolled 312 patients. Gram-negative bacteria, Gram-positive bacteria and Candida spp. were the cause of BSI episodes in 53%, 47% and 7% of cases, respectively. The 30-day mortality rate was 25% and best predicted by the SOFA and CLIF-SOFA score. In a Cox-regression model, delayed (>24h) antibiotic treatment [HR 7.58 (95%CI 3.29-18.67), P<.001], inadequate empirical therapy [HR 3.14 (95%CI 1.93-5.12), P<.001] and CLIF-SOFA score [HR 1.35 (95%CI 1.28-1.43), P<.001] were independently associated with 30-day mortality. Independent risk factors for MDRO (31% of BSIs) were previous antimicrobial exposure [OR 2.91 (95%CI 1.73-4.88), P<.001] and previous invasive procedures [OR 2.51 (95%CI 1.48-4.24), P=.001], whereas spontaneous bacterial peritonitis as BSI source was associated with a lower odds of MDRO [OR 0.30 (95%CI 0.12-0.73), P=.008). Conclusions MDRO account for nearly one-third of BSI in cirrhotic patients and often resulting in delayed or inadequate empirical antimicrobial therapy and increased mortality rates. Our data suggest that improved prevention and treatment strategies for MDRO are urgently needed in the liver cirrhosis patients.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X17304263

You might also like
Discover & Discuss Important Research

Keeping up-to-date with research can feel impossible, with papers being published faster than you'll ever be able to read them. That's where Researcher comes in: we're simplifying discovery and making important discussions happen. With over 19,000 sources, including peer-reviewed journals, preprints, blogs, universities, podcasts and Live events across 10 research areas, you'll never miss what's important to you. It's like social media, but better. Oh, and we should mention - it's free.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.