Prevalence of Bacterial Resistance in Hospitalized Cirrhotic Patients in Southern Brazil: A New Challenge

Abstract

Background & Aims:An increased frequency of infections by multiresistant bacteria has been described in hospitalized patients. The aim of this study was to evaluate the bacterial resistance profile in cirrhotic patients. Methods:This is a retrospective observational study. We assessed the antimicrobial susceptibility of 5,839 bacterial isolates from patients with and without cirrhosis. Regarding the multidrug resistance, we evaluated 4,505 bacterial isolates from 2,180 patients. Results:Two hundred and fifty-one patients had cirrhosis (mean age 57.6 ± 11 years; 61.8% were male, 47.8% of cases associated with hepatitis C virus). Of the isolates of patients with and without cirrhosis, 174/464 (37.5%) and 1,783/4,041 (44.1%) were multiresistant, respectively (p = 0.007). E. coli was the most common multiresistant bacteria in both groups. Approximately 20% of E. coli and Klebsiella sp. isolates were ESBL-producers and 44% of S. aureus isolates were methicillin-resistant in cirrhotic patients. In cirrhotic patients admitted to the emergency department, hospital ward, and intensive care unit, 28.3%, 50% and 40% had multiresistant isolates, respectively. In patients with and without cirrhosis, 36.2% and 33.5% of isolates were resistant to third-generation cephalosporins, respectively. Conclusions: The empirical treatment of infections in hospitalized patients using broad-spectrum antibiotics should consider the observed pattern of bacterial resistance.

High Prevalence of Multidrug Resistant Bacteria in Cirrhotic Patients with Spontaneous Bacterial Peritonitis: Is It Time to Change the Standard Antimicrobial Approach?

“…Third-generation cephalosporins resistance is of particular interest, once this class is recommended as first-line empirical treatment by international guidelines [11, 13]. We reported a 22% overall resistance rate among SBP cases (14% and 45% for CA and nosocomial infections, respectively), which is inside the previous reported rates that ranged widely from 15% to 45% [5, 7, 18]. A recent meta-analysis [20] evaluated third-generation cephalosporin resistance in 8 studies and concluded that this class should be used with caution, especially in centers where resistance patterns are not available.…”

“…In the past decade, prevalence of MDR bacterial infections has increased substantially, what is consistent among serial studies from different geographical regions [2–8, 19]. In SBP infections, for instance, Fernández et al (Spain, 2012) [3], Oliveira et al (Portugal, 2016) [4], Costabeber et al (Brazil, 2016) [5], Oey et al (Netherlands, 2017) [7], and Sofjan et al (USA, 2018) [18] have reported MDR prevalence of 22, 20, 37, 32, and 30%, respectively. We have found a slightly higher proportion than previous studies (39.8%), but it should be noted that this rate is considerably different when MDR and XDR germs are put together (46.9%) and reaches 53.7% when only nosocomial infections are considered.…”

Influence of proton pump inhibitors in the development of spontaneous bacterial peritonitis

“…The low mortality observed in patients with SBP in relation to the group without this infection is probably related to the fact that these infections are community-acquired, which results in a lower severity. We recently published a study showing the relevance of multiresistant bacteria in patients with nosocomial SBP, which certainly worsens the prognosis of these patients[ 43 ]. However, when patients with a greater impairment of hepatocellular function were evaluated (Child C), mortality was higher.…”

Bacterial Infections in Cirrhotic Patients in a Tertiary Care Hospital

“…Studies have documented the increase in MDR infections, ranging from 23-47%. [18][19][20] Prior studies have shown that nosocomial infections, long-term nor-floxacin prophylaxis, infection by MDR bacteria in the last 6 months, and recent use of beta-lactam antibiotics have all been independently associated as risk factors for the development of MDR infections in cirrhotic patients. 18 More recently, Piano et al 21 performed a multicenter, intercontinental, prospective study evaluating the prevalence of bacterial and fungal infections in patients with cirrhosis.…”

“…Studies have shown, however, evidence of bacterial resistance to third generation cephalosporins in 21.5% to 57% of SBP cases in Europe, with only 67% efficiency of empirical treatment with these agents. 19 As a result, the European Association for the Study of the Liver (known as EASL) established guidelines advocating for stronger empiric antibiotics in nosocomial infections (piperacillin-tazobactam or meropenem +/− glycopeptide), with mention that these choices should be tailored to the prevalent MDR bacteria of the local area. 23 The most recent guidelines set by EASL recommend that healthcare-associated infections should be treated with carbapenems like nosocomial infections if the prevalence of MDR organisms is high in the area.…”