Infections caused by bacteria with multiple drug resistance (MDR), which are characteristic for patients with cirrhosis, significantly increases in-hospital mortality. A larger study was presented at the International Congress on liver diseases 2018 (International Liver Congress – ILC).
The study included 1302 patients with cirrhosis and bacterial or fungal infections. The endpoint was defined as death of patient, liver transplantation or the end of the study. Participants were treated in 46 medical centers in North and South America, Europe, Africa and Asia.
It is noted that 77% of patients were diagnosed with ascites, 35% of acute and chronic liver failure. Alcoholic cirrhosis of the liver suffered by 52% of participants with liver cirrhosis as a result of infection With hepatitis C and 20%, hepatitis b – 8%, nonalcoholic steatohepatitis and 10%, the remaining 10% of patients had liver cirrhosis of unknown origin.
Among the most common infections were spontaneous bacterial peritonitis (27%), urinary tract infection (22%) and pneumonia (19%). Common infectious agents was considered to be Escherichia coli, Klebsiella pneumonia, Enterococcus, Staphylococcus aureus and Pseudomnoas areuginosa.
The global prevalence of MDR bacteria was 34%, with extensively drug-resistant – gram-negative bacteria resistant to almost all available drugs is 8%, the researchers reported.
The results showed that bacterial infection with MDR less likely than other bacteria that responded to empirical antibiotic therapy (40% and 68%, respectively). In addition, patients with infections with MDR significantly more likely to experience septic shock and organ failure. Infections with MDR were allowed with a lower probability and were associated with a significantly higher mortality in hospital.
“Multidrug-resistant bacteria are quite common in patients with cirrhosis, especially in Asia and India, noted the researchers. – It is not surprising that the mortality rate in hospital patients with infections with a broad and multi-drug-resistant and cirrhosis was 43%. This compared with 27% in patients with infections with MDR and 21% among patients without infections”.
The researchers called the results “quite troubling” and noted the need for more active screening of patients potentially at risk and isolate them if necessary.
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