Norfloxacin prophylaxis effect on multidrug resistance in patients with cirrhosis and bacterial infections

Marciano, Sebastián; Gutierrez-Acevedo, María Nelly; Barbero, Sabrina; Notari, Lorena Del Carmen; Agozino, Marina; Fernández, José Luis Fernández; Anders, Maria Margarita; Grigera, Nadia; Antinucci, Florencia; Ganem, Orlando F Orozco; Murga, Maria Dolores; Pérez, Daniela; Palazzo, Ana Gracia; Rejtman, Liria Martinez; Duarte, Ivonne Giselle; Vorobioff, Julio; Trevizan, Victoria; Bulaty, Sofía; Bessone, Fernando; Valverde, Marcelo; Elizondo, Martín; Bosia, José D; Borzi, Silvia; Stieben, Teodoro E.; Masola, Adriano Carlos; Ferretti, Sebastian Eduardo; Arufe, Diego; Demirdjian, Ezequiel; Raffa, María Pia; Peralta, Mirta; Fainboim, Hugo; Vazquez, Cintia Elizabet; Ruiz, Pablo; Martínez, José Emanuel; Heffner, Leandro Alfredo; Odzak, Andrea; Dirchwolf, Melisa; Smud, Astrid; Mendizábal, Manuel; Bellizzi, Carla; Martinez, A.; Tomatis, Jesica; Bruno, Andrés; Ramos, Agñel; Pages, Josefina; Tevez, Silvina; Gadano, Adrián; Giunta, Diego

doi:10.1007/s10096-023-04572-2

Cited by 3 publications

(1 citation statement)

References 22 publications

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“…There is a reported association between asymptomatic intestinal colonization with MDROs and prophylactic norfloxacin, leading to an inadvertent increase in nosocomial MDRO infections [17,27]. However, this is contentious, as four major studies conducted across the world have reported no increase in MDRO with prophylactic use of norfloxacin [6,10,14,28]. Similarly, in the current study, there was no association between norfloxacin prophylaxis and MDROs.…”

Section: Discussionsupporting

confidence: 41%

Predictors and Outcomes of Infections in ICU Patients With Cirrhosis: A Single-Center Observational Study

Kulkarni,

Rakam,

Avadhanam

et al. 2023

Cureus

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Background: Patients with cirrhosis are susceptible to infections, especially by multidrug-resistant organisms (MDROs). There are limited data on the incidence of culture-positive infections and the validity of Sepsis 3-criteria in patients with cirrhosis admitted to the intensive care unit (ICU) in India, which we aimed to assess.Methods: In this prospective study, we included consecutive patients with cirrhosis admitted to the ICU between November 1, 2021, and April 30, 2022. The primary objective was to compare the outcomes of patients with microbiologically proven infections with those without proven infections. The secondary objective was to assess the predictors of infections and mortality and the impact of drug-resistant organisms.Results: A total of 298 patients (9.4% women) were included. The incidence of microbiologically proven infection was 34% (101/298; 95%CI=27.6-41.2). Most patients (61%) had healthcare-associated infections, Gram-negative organisms accounted for 75.3%, and bacteremia was the commonest site. Drug-resistant organisms accounted for 52.5% (53/101; 95%CI=39.3-68.7), of which 39.6% were multidrug-resistant (MDR) and 12.8% were extensively drug-resistant (XDR). Mortality was significantly higher in patients with proven infections than those without (61.4% vs. 44.2%; P=0.007). The sequential organ failure assessment (SOFA) score (OR=1.91; 95%CI=1.04-3.52; P<0.001) and presence of fever and/or positive quick SOFA (qSOFA; OR=1.91;1.04-3.52; P=0.03) were associated with an increased risk of infections. The SOFA score (OR=1.06;95%CI=1.002-1.12; P=0.04), MELD NA score (OR=1.08;95%CI=1.05-1.12; P<0.001), and presence of fever and/or positive qSOFA (OR=2.19; 95%CI=1.27-3.76; P=0.005) predicted mortality.Conclusions: One-third of the patients with cirrhosis admitted to the ICU had microbiologically proven infection, and the mortality rate in such patients was high. SOFA, qSOFA, and fever can predict microbiologically proven infections and mortality in patients with cirrhosis.

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Section: Discussionsupporting

confidence: 41%

Predictors and Outcomes of Infections in ICU Patients With Cirrhosis: A Single-Center Observational Study

Kulkarni,

Rakam,

Avadhanam

et al. 2023

Cureus

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Multidrug-resistant bacterial infections after liver transplantation: Prevalence, impact, and risk factors

Martin-Mateos,

Martínez-Arenas,

Carvalho-Gomes

et al. 2024

Journal of Hepatology

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Antibiotics in Chronic Liver Disease and Their Effects on Gut Microbiota

Mendez-Sanchez,

Coronel-Castillo,

Cordova-Gallardo

et al. 2023

Antibiotics

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Impairments in liver function lead to different complications. As chronic liver disease progresses (CLD), hypoalbuminemia and alterations in bile acid compositions lead to changes in gut microbiota and, therefore, in the host–microbiome interaction, leading to a proinflammatory state. Alterations in gut microbiota composition and permeability, known as gut dysbiosis, have important implications in CLD; alterations in the gut–liver axis are a consequence of liver disease, but also a cause of CLD. Furthermore, gut dysbiosis plays an important role in the progression of liver cirrhosis and decompensation, particularly with complications such as hepatic encephalopathy and spontaneous bacterial peritonitis. In relation to this, antibiotics play an important role in treating CLD. While certain antibiotics have specific indications, others have been subjected to continued study to determine whether or not they have a modulatory effect on gut microbiota. In contrast, the rational use of antibiotics is important, not only because of their disrupting effects on gut microbiota, but also in the context of multidrug-resistant organisms. The aim of this review is to illustrate the role of gut microbiota alterations in CLD, the use and impact of antibiotics in liver cirrhosis, and their harmful and beneficial effects.

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Norfloxacin prophylaxis effect on multidrug resistance in patients with cirrhosis and bacterial infections

Cited by 3 publications

References 22 publications

Predictors and Outcomes of Infections in ICU Patients With Cirrhosis: A Single-Center Observational Study

Predictors and Outcomes of Infections in ICU Patients With Cirrhosis: A Single-Center Observational Study

Multidrug-resistant bacterial infections after liver transplantation: Prevalence, impact, and risk factors

Antibiotics in Chronic Liver Disease and Their Effects on Gut Microbiota

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