Healthcare‐associated and nosocomial bacterial infections in cirrhosis: predictors and impact on outcome

Sargenti, Konstantina; Prytz, Hanne; Strand, Anna Söderlund; Nilsson, Emma; Kalaitzakis, Evangelos

doi:10.1111/liv.12625

Cited by 44 publications

(41 citation statements)

References 38 publications

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“…In any case, subsequent infections occurring within 6 months after discharge after the index hospitalization (ie, all infections registered during follow-up evaluation in the study 1 ), would be considered HCA (or HA if they occurred >48 h after hospital admission), 3 and thus the presented data, which suggest a relationship between PPI use and subsequent HCA/HA infections, seem to be consistent with our findings. 2 Taken together, the findings of O'Leary et al 1 and those of our study 2 suggest that the use of PPIs is a predictor of subsequent HCA/HA infections after discharge after hospitalization for a bacterial infection. As O'Leary et al 1 pointed out in their article, the observed associations between PPI use and subsequent HCA/HA infections do not necessarily imply a causal link.…”

Section: Subsequent Bacterial Infections In Patients With Cirrhosis Asupporting

confidence: 79%

“…However, second HCA/HA infections occurred more frequently after a first inpatient HCA/HA infection episode in PPI users ( Figure 1B), in particular, in those with more than 1 daily defined dose of PPIs (P ¼ .019). 2 Unfortunately, it is unclear what the proportions of the different acquisition types of the index infections in the cohort of O'Leary et al 1 were because these were not presented in their article. In any case, subsequent infections occurring within 6 months after discharge after the index hospitalization (ie, all infections registered during follow-up evaluation in the study 1 ), would be considered HCA (or HA if they occurred >48 h after hospital admission), 3 and thus the presented data, which suggest a relationship between PPI use and subsequent HCA/HA infections, seem to be consistent with our findings.…”

Section: Subsequent Bacterial Infections In Patients With Cirrhosis Amentioning

confidence: 95%

“…We recently performed a retrospective population-based study investigating the occurrence and predictors of healthcare associated (HCA) and hospital-acquired (HA) infections in 633 patients with cirrhosis during a 10-year period of time (2276 patient-years). 2 We found that 68% of in-hospital episodes related to a bacterial infection occurring during the study period were caused by HCA or HA bacterial infections. Also, use of PPIs was more common in HA vs HCA vs community-acquired infections (80% vs 64% vs 44%; P < .001).…”

Section: Subsequent Bacterial Infections In Patients With Cirrhosis Amentioning

confidence: 96%

“…(A) Proportions of patients with a subsequent (second) bacterial infection of any acquisition type. (B) Proportions of patients with a subsequent (second) HCA/HA infection after discharge from the hospital after a first HCA/HA infection.Figure 1Bhas been published with permission from Sargenti et al2 …”

mentioning

confidence: 97%

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Subsequent Bacterial Infections in Patients With Cirrhosis and the Role of Proton-Pump Inhibitors

Sargenti

Kalaitzakis

2015

Clinical Gastroenterology and Hepatology

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Section: Subsequent Bacterial Infections In Patients With Cirrhosis Asupporting

confidence: 79%

Section: Subsequent Bacterial Infections In Patients With Cirrhosis Amentioning

confidence: 95%

Section: Subsequent Bacterial Infections In Patients With Cirrhosis Amentioning

confidence: 96%

mentioning

confidence: 97%

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Subsequent Bacterial Infections in Patients With Cirrhosis and the Role of Proton-Pump Inhibitors

Sargenti

Kalaitzakis

2015

Clinical Gastroenterology and Hepatology

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“…10,11 Frequent need for hospitalization, invasive procedures and, use of indwelling devices such as central venous line or transjugular intrahepatic portosystemic shunt (TIPS), give to the exogenous route an additional pathogenetic rule, further increasing the overall risk, mainly in the setting of Health Care Associated or Hospital Acquired infections. 12,13 BSIs in LC are also associated with high mortality, prolonged hospitalization and faster escalation of the liver disease. 14,15 In different studies including both cirrhotic and non-cirrhotic patients with bacteriemia or candidemia, LC was found to be an independent predictor of mortality.…”

Section: Introductionmentioning

confidence: 99%

Bloodstream infections in patients with liver cirrhosis

et al. 2016

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Bloodstream infections are a serious complication in patients with liver cirrhosis. Dysregulated intestinal bacterial translocation is the predominant pathophysiological mechanism of infections in this setting. For this reason enteric Gram-negative bacteria are commonly encountered as the first etiological cause of infection. However, through the years, the improvement in the management of cirrhosis, the recourse to invasive procedures and the global spread of multidrug resistant pathogens have importantly changed the current epidemiology. Bloodstream infections in cirrhotic patients are characterized by high mortality rate and complications including metastatic infections, infective endocarditis, and endotipsitis (or transjugular intrahepatic portosystemic shunt-related infection). For this reason early identification of patients at risk for mortality and appropriated therapeutic management is mandatory. Liver cirrhosis can significantly change the pharmacokinetic behavior of antimicrobials. In fact hypoproteinaemia, ascitis and third space expansion and impairment of renal function can be translated in an unpredictable drug exposure.

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An empirical broad spectrum antibiotic therapy in health‐care–associated infections improves survival in patients with cirrhosis: A randomized trial

et al. 2016

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Early diagnosis and appropriate treatment of infections in cirrhosis are crucial because of their high morbidity and mortality. Multidrug-resistant (MDR) infections are on the increase in health care settings. Health-care-associated (HCA) infections are still frequently treated as community-acquired with a detrimental effect on survival. We aimed to prospectively evaluate in a randomized trial the effectiveness of a broad spectrum antibiotic treatment in patients with cirrhosis with HCA infections. Consecutive patients with cirrhosis hospitalized with HCA infections were enrolled. After culture sampling, patients were promptly randomized to receive a standard or a broad spectrum antibiotic treatment (NCT01820026). The primary endpoint was in-hospital mortality. Efficacy, side effects, and the length of hospitalization were considered. Treatment failure was followed by a change in antibiotic therapy. Ninety-six patients were randomized and 94 were included. The two groups were similar for demographic, clinical, and microbiological characteristics. The prevalence of MDR pathogens was 40% in the standard versus 46% in the broad spectrum group. In-hospital mortality showed a substantial reduction in the broad spectrum versus standard group (6% vs. 25%; P 5 0.01). In a post-hoc analysis, reduction of mortality was more evident in patients with sepsis. The broad spectrum showed a lower rate of treatment failure than the standard therapy (18% vs. 51%; P 5 0.001). Length of hospitalization was shorter in the broad spectrum (12.3 6 7 days) versus standard group (18 6 15 days; P 5 0.03). Five patients in each group developed a second infection during hospitalization with a similar prevalence of MDR (50% broad spectrum vs. 60% standard). Conclusions: A broad spectrum antibiotic therapy as empirical treatment in HCA infections improves survival in cirrhosis. This treatment was significantly effective, safe, and cost saving. (HEPATOLOGY 2016;63:1632-1639 B acterial infections are a frequent and lifethreatening complication in chronic liver disease; despite the improvement in diagnostic and therapeutic measures, infection-related morbidity and mortality still play a prominent role in these patients. (1)(2)(3)(4) The most likely explanation for this persistent high mortality is the growing spread of multiresistant pathogens with a consequent reduction in the rate of treatment success with empirical standard antibiotic therapies. This problem has been raised by several researchers in the last decade. (5)(6)(7)(8) A timely initiation of antibiotic treatment is strongly recommended in these patients, particularly in the case of severe infections. This recommendation arises from the observation that a delay in starting empirical antibiotics is associated with an

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Healthcare‐associated and nosocomial bacterial infections in cirrhosis: predictors and impact on outcome

Cited by 44 publications

References 38 publications

Subsequent Bacterial Infections in Patients With Cirrhosis and the Role of Proton-Pump Inhibitors

Subsequent Bacterial Infections in Patients With Cirrhosis and the Role of Proton-Pump Inhibitors

Bloodstream infections in patients with liver cirrhosis

An empirical broad spectrum antibiotic therapy in health‐care–associated infections improves survival in patients with cirrhosis: A randomized trial

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