Antimicrobial resistance in patients with decompensated liver cirrhosis and bacterial infections in a tertiary center in Northern Germany

Abstract

Background and aims Bacterial infections are common in patients with decompensated liver cirrhosis and a leading cause of death. Reliable data on antibiotic resistance are required to initiate effective empiric therapy. We here aim to assess the antimicrobial resistance profile of bacteria among patients with liver cirrhosis and infection. Methods Overall, 666 cirrhotic patients admitted to Hannover Medical School between January 2012 and April 2018 with ascites were assessed for bacterial infection. In case of infection, bacteria cultured from microbiological specimens of ascites, blood or urine were identified and analyzed for resistances against common antibiotic agents. Furthermore, analyses compared two periods of time and community-acquired vs. nosocomial infections. Results In 281 patients with infection, microbiological sampling was performed and culture-positive results were obtained in 56.9%. Multidrug-resistant (MDR)-bacteria were found in 54 patients (19.2%). Gram-positive organisms were more common (n = 141/261, 54.0%) and detected in 116/192 culture-positive infections (60.4%). Comparing infections before and after 2015, a numerical decline for MDR-bacteria (23.8% vs. 15.6%, p = 0.08) was observed with a significant decline in meropenem resistance (34.9% vs. 19.5%, p = 0.03). MDR-bacteria were more frequent in the case of nosocomial infections. Of note, in ascites the majority of the tested bacteria were resistant against ceftriaxone (73.8%) whereas significantly less were resistant against meropenem (27.0%) and vancomycin (25.9%). Conclusions In our tertiary center, distinct ratios of gram-positive infection with overall low ratios of MDR-bacteria were found. Adequate gram-positive coverage in the empiric therapy should be considered. Carbapenem treatment may be omitted even in nosocomial infection. In contrast, 3rd generation cephalosporins cannot be recommended even in community-acquired infection in our cirrhotic population.

Retrospective study of the incidence, risk factors, treatment outcomes of bacterial infections at uncommon sites in cirrhotic patients

“…Our data showed an empirically more frequent antibiotic coverage in the gram-positive spectrum with, however, more frequent detection of a gram-negative infection. Hillert et al [ 16 ] found, that a gram-positive pathogen was detected in 54% of cases, with the most common single pathogen detection being E. coli . Hillert et al [ 16 ] inclusion criterion was the presence of ascites.…”

“…Hillert et al [ 16 ] found, that a gram-positive pathogen was detected in 54% of cases, with the most common single pathogen detection being E. coli . Hillert et al [ 16 ] inclusion criterion was the presence of ascites.…”

Clinical impact of multidrug-resistant bacterial infections in patients with cirrhosis

“…ESBL Enterobacteriaceae, mainly E. coli and K. pneumonia , were predominant in almost all previous studies [ 7 , 11 , 23 , 24 ]. However, the share of gram-positive cocci represented by MSRA and VSE or VRE has increased significantly in recent years worldwide [ 24 ], particularly in European and American centers [ 11 , 25 , 26 ]. This trend can be explained by the increased use of invasive maneuvers in these centers [ 6 ].…”

Acute upper and lower gastrointestinal bleeding management in older people taking or not taking anticoagulants: a literature review

“…However, drug should be selected considering patients characteristics, such as comorbidities and previous exposure to antibiotics, as people above the age of 65 years may have hepatic or renal impairments, which may affect drug metabolism and elimination; for instance, a pharmacokinetic study on older patients with moderate-to-severe impairment in renal function has highlighted a greater ceftriaxone exposure with a 48 h dosing schedule (50). Similarly, bacterial characteristics should be considered as well, as a local pattern of ceftriaxone and quinolone resistance in cirrhotic patients have been reported (51,52).…”