Clinical and microbiological characteristics of bacterial infections in patients with cirrhosis. A prospective cohort study from Argentina and Uruguay

• DOI: 10.1016/j.aohep.2023.101097
• Publication Date: 2023-04-06T06:34:29Z
• Authors: Carolina Vazquez; María Nelly Gutie...; Sabrina Barbero; Lorena del Carmen...; Marina Agozino; José Luis Fernandez; María Margarita A...; Nadia Lorena Grigera; Florencia Antinucci; Orlando Nicolas F...; María Dolores Murga; María Daniela Perez; Ana Gracia Palazzo; Liria Martinez Re...; Ivonne Giselle Du...; Julio Daniel Voro...; Victoria Trevizan; Sofía Bulaty; Fernando Bessone; Marcelo Valverde; Martín Elizondo; Silvia Mabel Borzi; Teodoro Eduardo S...; Adriano Carlos Ma...; Sebastian Eduardo...; Diego Arufe; Ezequiel Demirdjian; María Pia Raffa; Mirta Peralta; Hugo Alberto Fain...; Cintia Elizabet V...; Pablo Marcelo Ruiz; José Emanuel Mart...; Leandro Alfredo H...; Andrea Odzak; Melisa Dirchwolf; Astrid Smud; Manuel Mendizabal; Pablo Anibal Calz...; Ana Martinez; Jesica Tomatis; Andres Bruno; Agñel Ramos; Josefina Pages; Silvina Tevez; Adrian Carlos Gadano; Diego Hernan Giunta; Sebastián Marciano
• Keywords: Liver Cirrhosis; Cross Infection; Bacteria; Argentina; Specialties of internal medicine; Bacterial Infections; Multidrug resistance; Antimicrobial agents; 3. Good health; Anti-Bacterial Agents; Community-Acquired Infections; RC581-951; Antibiotics; Urinary Tract Infections; Humans; Uruguay; Prospective Studies

there is insufficient data regarding bacterial infections in patients with cirrhosis to support recommendations for empiric antibiotic treatments, particularly in Latin America. This study aimed to evaluate bacterial infection's clinical impact and microbiological characteristics, intending to serve as a platform to revise current practices.multicenter prospective cohort study of patients with cirrhosis and bacterial infections from Argentina and Uruguay. Patient and infection-related information were collected, focusing on microbiology, antibiotic susceptibility patterns, and outcomes.472 patients were included. Spontaneous bacterial infections and urinary tract infections (UTIs) were registered in 187 (39.6%) and 116 (24.6%) patients, respectively, representing the most common infections. Of the 256 culture-positive infections, 103 (40.2%) were caused by multidrug-resistant organisms (reaching 50% for UTI), and 181 (70.7%) received adequate initial antibiotic treatment. The coverage of cefepime and ceftriaxone was over 70% for the empirical treatment of community-acquired spontaneous infections, but ceftazidime´s coverage was only 40%. For all UTI cases and for healthcare-associated or nosocomial spontaneous bacterial infections, the lower-spectrum antibiotics that covered at least 70% of the isolations were imipenem and meropenem. During hospitalization, a second bacterial infection was diagnosed in 9.8% of patients, 23.9% required at least one organ support, and 19.5% died.short-term mortality of bacterial infections in patients with cirrhosis is very high, and a high percentage were caused by multidrug-resistant organisms, particularly in UTIs. The information provided might serve to adapt recommendations, particularly related to empirical antibiotic treatment in Argentina and Uruguay. The study was registered in Clinical Trials (NCT03919032).