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Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide

Title
Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide
Authors
Piano, SalvatoreSingh, VirendraCaraceni, PaoloMaiwall, RakhiAlessandria, CarloFernandez, JavierSoares, Elza CotrimKim, Dong JoonKim, Sung EunMarino, MonicaVorobioff, JulioRibeiro Barea, Rita de CassiaMerli, ManuelaElkrief, LaureVargas, VictorKrag, AleksanderSingh, Shivaram PrasadLesmana, Laurentius AdriantoToledo, ClaudioMarciano, SebastianVerhelst, XavierWong, FlorenceIntagliata, NicolasRabinowich, LianeColombato, LuisKim, Sang GyuneGerbes, AlexanderDurand, FrancoisPablo Roblero, JuanBhamidimarri, Kalyan RamBoyer, Thomas D.Maevskaya, MarinaFassio, EduardoKim, Hyoung SuHwang, Jae SeokGines, PereGadano, AdrianSarin, Shiv KumarAngeli, PaoloBartoletti, MicheleBrodersen, CarlosBruns, Tonyde Man, Robert A.Fialla, Annette DamGambino, CarmineGautam, VikasGirala, MarcosJuanola, AdriaKim, Jeong HanKim, Tae HunKumar, PramodLattanzi, BarbaraLee, Tae HeeLesmana, Cosmas A. RinaldiMoreau, RichardNath, PreetamNavarro, GustavoPark, Ji-WonPinero, GiselaPyrsopoulos, Nikolaos T.Restellini, SophieRomero, GustavoSacco, MarcoSeva-Pereira, TiagoSimon-Talero, MacarenaSong, Do SeonSuk, Ki TaeVan Vlierberghe, HansYim, Sun YoungYoon, Eileen LaurelZaccherini, GiacomoInt Club Ascites Global Study Grp
Ewha Authors
김태헌
SCOPUS Author ID
김태헌scopus
Issue Date
2019
Journal Title
GASTROENTEROLOGY
ISSN
0016-5085JCR Link

1528-0012JCR Link
Citation
GASTROENTEROLOGY vol. 156, no. 5, pp. 1368 - +
Keywords
GlobalResistanceSepsisStewardship
Publisher
W B SAUNDERS CO-ELSEVIER INC
Indexed
SCI; SCIE; SCOPUS WOS
Document Type
Article
Abstract
BACKGROUND & AIMS: Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis. METHODS: We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge. RESULTS: The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%-37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival. CONCLUSIONS: In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.
DOI
10.1053/j.gastro.2018.12.005
Appears in Collections:
의과대학 > 의학과 > Journal papers
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