The Importance of Knowing the Local Epidemiology When a Patient With Cirrhosis Acquires a Bacterial Infection

Marciano, Sebastián; Valverde, Marcelo; Dirchwolf, Melisa; Gutierrez-Acevedo, María Nelly; Gadano, Adrián

doi:10.1002/cld.911

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…Active monitoring of local bacterial epidemiology, with up-to-date online data and feedback to the Transplant Infectious Diseases team, is critical to ensure adequate empiric antibiotic treatment, pending identification of the bacteria and antimicrobial susceptibility test (AST), in the case of suspected/proven post-OLT bacterial infection [ 57 ].…”

Section: Resultsmentioning

confidence: 99%

“…This can be challenging but is necessary especially in endemic areas for MDROs, such as ESBL Enterobacterales, KPC-producing Klebsiella spp., NDM-producing Enterobacterales, MDR Pseudomonas aeruginosa , MRSA, VRE, and carbapenem-resistant Acinetobacter spp. [ 57 , 58 , 59 ]. When a post-OLT abdominal infection is suspected, blood cultures and radiological imaging (e.g., ultrasound and/or CT scan) should be performed to exclude post-surgical abscess and the need for possible source control [ 17 ].…”

Section: Resultsmentioning

confidence: 99%

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Early Intra-Abdominal Bacterial Infections after Orthotopic Liver Transplantation: A Narrative Review for Clinicians

et al. 2023

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Despite recent advances in the transplant field, infectious complications after orthotopic liver transplantation (OLT) are major causes of morbidity and mortality. Bacterial intra-abdominal infections (IAIs) are predominant during the first month post-transplantation and affect patient and graft survival. Recently, the emergence of multidrug resistant bacteria has generated great concern in OLT patients. We performed this narrative review of the literature in order to propose a “ready-to-use” flowchart for reasoned empirical antibiotic therapy in the case of suspected post-OLT IAIs. The review was ultimately organized into four sections: “Epidemiology and predisposing factors for IAI”; “Surgical-site infections and perioperative prophylaxis”; “MDRO colonization and infections”; and “Reasoned-empirical antibiotic therapy in early intra-abdominal infections post OLT and source control”. Multidisciplinary teamwork is warranted to individualize strategies for the prevention and treatment of IAIs in OLT recipients, taking into account each patient’s risk factors, the surgical characteristics, and the local bacterial epidemiology.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Early Intra-Abdominal Bacterial Infections after Orthotopic Liver Transplantation: A Narrative Review for Clinicians

et al. 2023

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“…It is known that keeping an active surveillance program that performs periodic reports and recommendations requires a multidisciplinary expert team, is time-consuming, and is costly[ 49 ]. Therefore, scientific societies or governmental organizations should implement and lead these programs and report their results at different levels.…”

Section: Introductionmentioning

confidence: 99%

Challenges and recommendations when selecting empirical antibiotics in patients with cirrhosis

Dirchwolf¹,

Perdiguero²,

Grech³

et al. 2023

World J Hepatol

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There is abundant evidence that bacterial infections are severe complications in patients with cirrhosis, being the most frequent trigger of acute-on-chronic liver failure and causing death in one of every four patients during hospitalization. For these reasons, early diagnosis and effective treatment of infections are mandatory to improve patient outcomes. However, treating physicians are challenged in daily practice since diagnosing bacterial infections is not always straightforward. This situation might lead to delayed antibiotic initiation or prescription of ineffective regimens, which are associated with poor outcomes. On the other hand, prescribing broad-spectrum antibiotics to all patients suspected of bacterial infections might favor bacterial resistance development. This is a significant concern given the alarming number of infections caused by multidrug-resistant microorganisms worldwide. Therefore, it is paramount to know the local epidemiology to propose tailored guidelines for empirical antibiotic selection in patients with cirrhosis in whom bacterial infections are suspected or confirmed. In this article, we will revise current knowledge in this area and highlight the importance of surveillance programs.

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“…The MDRO resistance profiles differ considerably among geographical areas [ 7 , 9 ]. There is relatively limited data on changing bacterial ecology in developing countries, particularly in cirrhotic patients.…”

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confidence: 99%

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

Trad,

Mohamed,

Bizid

et al. 2020

Future Science OA

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Aim: Recently, the emergency of multidrug-resistant organisms (MDRO) has complicated the management of bacterial infections (BI) in cirrhosis. We aimed to assess their clinical impact on patients with decompensated cirrhosis. Methods: A retrospective study included consecutive cirrhotic patients hospitalized for acute decompensation (AD) between January 2010 and December 2019. Results: A total of 518 AD admissions in 219 patients were included, with 260 BI episodes (50.2%). MDRO prevalence was 38.2% of the total isolates. Recent antibiotic use (OR = 4.91), nosocomial infection (OR = 2.95), and healthcare-associated infection (OR = 3.45) were their main risk factors. MDROs were associated with empiric treatment failure (OR = 23.42), a higher prevalence of sepsis (OR = 4.93), ACLF (OR = 3.42) and mortality. Conclusion: The clinical impact of MDROs was pejorative, with an increased risk of empiric treatment failure, organ failure and death.

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The Importance of Knowing the Local Epidemiology When a Patient With Cirrhosis Acquires a Bacterial Infection

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/16-3-reading-marciano a video presentation of this article

Cited by 3 publications

References 14 publications

Early Intra-Abdominal Bacterial Infections after Orthotopic Liver Transplantation: A Narrative Review for Clinicians

Early Intra-Abdominal Bacterial Infections after Orthotopic Liver Transplantation: A Narrative Review for Clinicians

Challenges and recommendations when selecting empirical antibiotics in patients with cirrhosis

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

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