The impact of infection by multidrug‐resistant agents in patients with cirrhosis. A multicenter prospective study

Abstract Bacterial strains resistant to antibiotics are a serious clinical challenge. We assessed the antibiotic susceptibility of bacteria isolated from infections in patients with cirrhosis by a multicentre investigation RESULTS: Three-hundred-thirteen culture-positive infections (173 community-acquired and 140 hospital-acquired) were identified in 308 patients. Urinary tract infections, spontaneous bacterial peritonitis and bacteremias were the most frequent. Quinolone-resistant Gram-negative isolates were 48%, 44% were ESBL producers and 9% carbapenem-resistant. In 83/313 culture-positive infections (27%), multidrug-resistant agents (MDRA) were isolated. This prevalence did not differ between community-acquired and hospital-acquired infections. MDRA were identified in 17 of 37 patients on quinolone prophylaxis, and in 46 of 166 not on prophylaxis (45% versus 27%; P<0.03). In 287 cases an empiric antibiotic therapy was undertaken, in 37 (12.9%) this therapy failed. The in-hospital mortality rate of this subset of patients was significantly higher compared to patients who received an effective broad(er)-spectrum therapy (P=0.038). During a 3-month follow-up, 56/203 culture-positive patients (27.6%) died, 24/63 who have had MDRA-related infections (38%) and 32/140 who have had antibiotic-susceptible infections (22.8%) (P=0.025). Multivariate analysis disclosed MDRA infection, age, hepatocellular carcinoma, bilirubin, INR, and the occurrence of portal-hypertension-related complications independent predictors of death CONCLUSIONS: Infection by MDRA is frequent in patients with cirrhosis and the prognosis is severe, especially in patients unresponsive to empiric antibiotic therapy. This article is protected by copyright. All rights reserved.