Universität zu Köln

Bartoletti, M., Giannella, M., Lewis, R., Caraceni, P., Tedeschi, S., Paul, M., Schramm, C., Bruns, T., Merli, M., Cobos-Trigueros, N., Seminari, E., Retamar, P., Munoz, P., Tumbarello, M., Burra, P., Cerenzia, M. Torrani, Barsic, B., Calbo, E., Maraolo, A. E., Petrosillo, N., Galan-Ladero, M. A., D'Offizi, G., Bar Sinai, N., Rodriguez-Bano, J., Verucchi, G., Bernardi, M. and Viale, P. (2018). A prospective multicentre study of the epidemiology and outcomes of bloodstream infection in cirrhotic patients. Clin. Microbiol. Infect., 24 (5). OXFORD: ELSEVIER SCI LTD. ISSN 1469-0691

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Abstract

Objectives: To describe the current epidemiology of bloodstream infection (BSI) in patients with cirrhosis; and to 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 was best predicted by the Sequential Organ Failure Assessment (SOFA) and Chronic Liver Failure-SOFA (CLIF-SOFA) score. In a Cox regression model, delayed (>24 hours) antibiotic treatment (hazard ratio (HR) 7.58; 95% confidence interval (CI) 3.29-18.67; p < 0.001), inadequate empirical therapy (HR 3.14; 95% CI 1.93-5.12; p < 0.001) and CLIF-SOFA score (HR 1.35; 95% CI 1.28-1.43; p < 0.001) were independently associated with 30-day mortality. Independent risk factors for MDRO (31% of BSIs) were previous antimicrobial exposure (odds ratio (OR) 2.91; 95% CI 1.73-4.88; p < 0.001) and previous invasive procedures (OR 2.51; 95% CI 1.48-4.24; p 0.001), 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 0.008). Conclusions: MDRO account for nearly one-third of BSI in cirrhotic patients, 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. (C) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bartoletti, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Giannella, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lewis, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Caraceni, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Tedeschi, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Paul, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schramm, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bruns, T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Merli, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cobos-Trigueros, N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Seminari, E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Retamar, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Munoz, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Tumbarello, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Burra, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cerenzia, M. Torrani UNSPECIFIED UNSPECIFIED UNSPECIFIED Barsic, B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Calbo, E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Maraolo, A. E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Petrosillo, N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Galan-Ladero, M. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED D'Offizi, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bar Sinai, N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rodriguez-Bano, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Verucchi, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bernardi, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Viale, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-186823
DOI:	10.1016/j.cmi.2017.08.001
Journal or Publication Title:	Clin. Microbiol. Infect.
Volume:	24
Number:	5
Date:	2018
Publisher:	ELSEVIER SCI LTD
Place of Publication:	OXFORD
ISSN:	1469-0691
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CLINICAL-FEATURES; BACTEREMIA; SEPSIS; DEFINITIONS; PROGNOSIS; MORTALITY; CRITERIA; FAILURE; ADULTS; IMPACT Multiple languages Infectious Diseases; Microbiology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/18682