Clinical and microbiological characteristics of bacterial infections in patients with cirrhosis. A prospective cohort study from Argentina and Uruguay

Introduction and Objectives: there is insufficient data regarding bacterial infections in patients with cirrhosis to support recommendations for empiric antibiotic treatments, particularly in Latin America. This study aimed to evaluate bacterial infection's clinical impact and microbiological characteristics, intending to serve as a platform to revise current practices. Materials and Methods: multicenter prospective cohort study of patients with cirrhosis and bacterial infections from Argentina and Uruguay. Patient and infection-related information were collected, focusing on microbiology, antibiotic susceptibility patterns, and outcomes. Results: 472 patients were included. Spontaneous bacterial infections and urinary tract infections (UTIs) were registered in 187 (39.6%) and 116 (24.6%) patients, respectively, representing the most common infections. Of the 256 culture-positive infections, 103 (40.2%) were caused by multidrug-resistant organisms (reaching 50% for UTI), and 181 (70.7%) received adequate initial antibiotic treatment. The coverage of cefepime and ceftriaxone was over 70% for the empirical treatment of community-acquired spontaneous infections, but ceftazidime´s coverage was only 40%. For all UTI cases and for healthcare-associated or nosocomial spontaneous bacterial infections, the lower-spectrum antibiotics that covered at least 70% of the isolations were imipenem and meropenem. During hospitalization, a second bacterial infection was diagnosed in 9.8% of patients, 23.9% required at least one organ support, and 19.5% died. Conclusions: short-term mortality of bacterial infections in patients with cirrhosis is very high, and a high percentage were caused by multidrug-resistant organisms, particularly in UTIs. The information provided might serve to adapt recommendations, particularly related to empirical antibiotic treatment in Argentina and Uruguay. The study was registered in Clinical Trials (NCT03919032).Fil: Vazquez, Carolina. Hospital Italiano; ArgentinaFil: Gutierrez-Acevedo, María Nelly. Hospital 4 de Junio; ArgentinaFil: Barbero, Sabrina. Complejo Medico Policial Bartolome Churruca Andres Visca; ArgentinaFil: Notari, Lorena del Carmen. Complejo Medico Policial Bartolome Churruca Andres Visca; ArgentinaFil: Agozino, Marina. Sanatorio Guemes; ArgentinaFil: Fernandez, José Luis. Sanatorio Guemes; ArgentinaFil: Anders, María Margarita. Hospital Alemán; ArgentinaFil: Grigera, Nadia Lorena. Hospital Aleman; ArgentinaFil: Antinucci, Florencia. Hospital Alemán; ArgentinaFil: Orozco Ganem, Orlando Nicolas Federico. Hospital Alemán; ArgentinaFil: Murga, María Dolores. Hospital A. C. Padilla; ArgentinaFil: Perez, María Daniela. Hospital A. C. Padilla; ArgentinaFil: Palazzo, Ana Gracia. Hospital A. C. Padilla; ArgentinaFil: Rejtman, Liria Martinez. Hospital Teodoro J. Schestakow; ArgentinaFil: Duarte, Ivonne Giselle. Hospital 4 de Junio; ArgentinaFil: Vorobioff, Julio Daniel. Hospital Provincial del Centenario; ArgentinaFil: Trevizan, Victoria. Hospital Provincial del Centenario; ArgentinaFil: Bulaty, Sofía. Hospital Provincial del Centenario; ArgentinaFil: Bessone, Fernando. Hospital Provincial del Centenario; ArgentinaFil: Valverde, Marcelo. Hospital de Clinicas Dr. Manuel Quintela; UruguayFil: Elizondo, Martín. Hospital de Clinicas Dr. Manuel Quintela; UruguayFil: Borzi, Silvia Mabel. Hospital Prof. Rodolfo Rossi; ArgentinaFil: Stieben, Teodoro Eduardo. Provincia de Entre Rios. Hospital San Martin; ArgentinaFil: Masola, Adriano Carlos. Provincia de Entre Rios. Hospital San Martin; ArgentinaFil: Tomatis, Jesica. Hospital Privado de Rosario; ArgentinaFil: Pages, Josefina. Universidad Austral; ArgentinaFil: Tevez, Silvina. Sanatorio Guemes; ArgentinaFil: Gadano, Adrián Carlos. Hospital Italiano; ArgentinaFil: Giunta, Diego Hernan. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Marciano, Sebastián. Hospital Italiano; Argentin

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

It is unclear whether norfloxacin predisposes to infections by multidrug-resistant organisms (MDROs). We aimed to evaluate if patients with cirrhosis receiving norfloxacin prophylaxis at the time of the diagnosis of bacterial infections were more likely to present a multidrug-resistant isolate than those without prophylaxis. This is a cross-sectional study of hospitalized patients with cirrhosis and bacterial infections from Argentina and Uruguay (NCT03919032) from September 2018 to December 2020. The outcome variable was a multidrug-resistant bacterial infection. We used inverse probability of treatment weighting to estimate the odds ratio (OR) of norfloxacin on infection caused by MDROs considering potential confounders. Among the 472 patients from 28 centers, 53 (11%) were receiving norfloxacin at the time of the bacterial infection. Patients receiving norfloxacin had higher MELD-sodium, were more likely to have ascites or encephalopathy, to receive rifaximin, beta-blockers, and proton-pump inhibitors, to have a nosocomial or health-care-associated infection, prior bacterial infections, admissions to critical care units or invasive procedures, and to be admitted in a liver transplant center. In addition, we found that 13 (24.5%) patients with norfloxacin and 90 (21.5%) of those not receiving it presented infections caused by MDROs (adjusted OR 1.55; 95% CI: 0.60–4.03; p = 0.360). The use of norfloxacin prophylaxis at the time of the diagnosis of bacterial infections was not associated with multidrug resistance. These results help empiric antibiotic selection and reassure the current indication of norfloxacin prophylaxis in well-selected patients. Study registration number: NCT03919032Fil: Marciano, Sebastián. Hospital Italiano; ArgentinaFil: Gutierrez Acevedo, Maria N.. Hospital 4 de Junio; ArgentinaFil: Barbero, Sabrina. Complejo Medico Policial Bartolome Churruca Andres Visca; ArgentinaFil: del C. Notari, Lorena. Complejo Medico Policial Bartolome Churruca Andres Visca; ArgentinaFil: Agozino, Marina. Sanatorio Guemes; ArgentinaFil: Fernandez, Jose L.. Sanatorio Guemes; ArgentinaFil: Anders, Maria M.. Hospital Alemán; ArgentinaFil: Grigera, Nadia. Hospital Alemán; ArgentinaFil: Antinucci, Florencia. Hospital Alemán; ArgentinaFil: Orozco Ganem, Orlando F.. Hospital Aleman; ArgentinaFil: Murga, Maria D.. Hospital A. C. Padilla; ArgentinaFil: Perez, Daniela. Hospital A. C. Padilla; ArgentinaFil: Palazzo, Ana. Hospital A. C. Padilla; ArgentinaFil: Martinez Rejtman, Liria. Hospital Teodoro J. Schestakow; ArgentinaFil: Duarte, Ivonne G.. Hospital 4 de Junio; ArgentinaFil: Vorobioff, Julio. Hospital Provincial del Centenario; ArgentinaFil: Trevizan, Victoria. Hospital Provincial del Centenario; ArgentinaFil: Bulaty, Sofía. Hospital Provincial del Centenario; ArgentinaFil: Bessone, Fernando. Hospital Provincial del Centenario; ArgentinaFil: Valverde, Marcelo. Hospital de Clinicas Dr. Manuel Quintela; UruguayFil: Elizondo, Martín. Hospital de Clinicas Dr. Manuel Quintela; UruguayFil: Bosia, José D.. Hospital Prof. Rodolfo Rossi, la Plata; ArgentinaFil: Borzi, Silvia M.. Hospital Prof. Rodolfo Rossi, la Plata; ArgentinaFil: Stieben, Teodoro E.. Provincia de Entre Rios. Hospital San Martin; ArgentinaFil: Masola, Adriano. Provincia de Entre Rios. Hospital San Martin; ArgentinaFil: Ramos, Agñel. Sanatorio Parque; ArgentinaFil: Pages, Josefina. Universidad Austral; ArgentinaFil: Tevez, Silvina. Sanatorio Guemes; ArgentinaFil: Gadano, Adrián Carlos. Hospital Italiano; ArgentinaFil: Giunta, Diego Hernan. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Clinical and microbiological characteristics of bacterial infections in patients with cirrhosis. A prospective cohort study from Argentina and Uruguay

Introduction and Objectives: there is insufficient data regarding bacterial infections in patients with cirrhosis to support recommendations for empiric antibiotic treatments, particularly in Latin America. This study aimed to evaluate bacterial infection's clinical impact and microbiological characteristics, intending to serve as a platform to revise current practices. Materials and Methods: multicenter prospective cohort study of patients with cirrhosis and bacterial infections from Argentina and Uruguay. Patient and infection-related information were collected, focusing on microbiology, antibiotic susceptibility patterns, and outcomes. Results: 472 patients were included. Spontaneous bacterial infections and urinary tract infections (UTIs) were registered in 187 (39.6%) and 116 (24.6%) patients, respectively, representing the most common infections. Of the 256 culture-positive infections, 103 (40.2%) were caused by multidrug-resistant organisms (reaching 50% for UTI), and 181 (70.7%) received adequate initial antibiotic treatment. The coverage of cefepime and ceftriaxone was over 70% for the empirical treatment of community-acquired spontaneous infections, but ceftazidime´s coverage was only 40%. For all UTI cases and for healthcare-associated or nosocomial spontaneous bacterial infections, the lower-spectrum antibiotics that covered at least 70% of the isolations were imipenem and meropenem. During hospitalization, a second bacterial infection was diagnosed in 9.8% of patients, 23.9% required at least one organ support, and 19.5% died. Conclusions: short-term mortality of bacterial infections in patients with cirrhosis is very high, and a high percentage were caused by multidrug-resistant organisms, particularly in UTIs. The information provided might serve to adapt recommendations, particularly related to empirical antibiotic treatment in Argentina and Uruguay. The study was registered in Clinical Trials (NCT03919032)