Proton pump inhibitor therapy does not increase the incidence of spontaneous bacterial peritonitis in cirrhosis: a multicenter prospective study

BACKGROUND & AIM Retrospective studies show an association between proton pump inhibitor (PPI) therapy and spontaneous bacterial peritonitis (SBP). We investigate the relationship between PPI and SBP in decompensated cirrhotic patients in a large nationwide prospective study. METHODS: Seven hundred seventy patients with a diagnosis of decompensated cirrhosis were admitted consecutively in 23 hospitals in Argentina from March 2011 to April 2012; the patients were carefully investigated for PPI consumption in the previous 3 months. In total, 251 patients were excluded because of active gastrointestinal hemorrhage, antibiotic use during the preceding weeks, HIV-positive status and immunosuppressive therapy. RESULTS: Two hundred twenty-six out of 519 patients (43.5%) had received PPI therapy within the last 3 months. In 135 patients, PPIs were administered for longer than 2 weeks. A bacterial infection was shown in 255 patients (49.1%). SBP was diagnosed in 95 patients out of 394 patients with ascites (24.7%). There was no significant difference in the rate of PPI consumption between the infected and the non-infected patients (44.3% vs. 42.8%) or between the SBP patients and the patients with ascites without SBP (46% vs. 42%). In the SBP patients, the duration of PPI administration did not influence the rate of SBP occurrence. The type of bacteria and the origin of SBP infection were similar in the patients with and without PPI.CONCLUSION: In the current large, multicenter, prospective study, PPI therapy, specifically evaluated at admission of consecutive cirrhotic patients, was not associated with a higher risk of SBP.Fil: Terg, Rubén. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología ; ArgentinaFil: Casciato, Paola. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Garbe, Cecilia. Ministerio de Salud de la Nación. Hospital Nacional Alejandro Posadas; ArgentinaFil: Cartier, Mariano. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología ; ArgentinaFil: Stieben Teodoro. Provincia de Entre Rios. Ministerio de Salud. Hospital San Martín; ArgentinaFil: Mendizabal, Manuel. Hospital Universitario Austral; ArgentinaFil: Niveyro, Carla. Provincia de Misiones. Hospital Escuela de Agudos Dr. Ramon Madariaga; ArgentinaFil: Benavides Javier. Hospital Británico de Buenos Aires; ArgentinaFil: Colombato, Luis. Hospital Británico de Buenos Aires; ArgentinaFil: Berbara, Daniel. Provincia de Misiones. Hospital Escuela de Agudos Dr. Ramón Madariaga; ArgentinaFil: Salgado, Pablo. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología ; ArgentinaFil: Barreyro, Fernando Javier. Hospital Británico de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Fassio, Eduardo. Ministerio de Salud de la Nación. Hospital Nacional Alejandro Posadas; ArgentinaFil: Gadano, Adrián Carlos. Hospital Italiano; 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).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

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)

A Latin American survey on demographic aspects of hospitalized, decompensated cirrhotic patients and the resources for their management

Introduction & objectives: Liver cirrhosis is a major cause of mortality worldwide. Adequate diagnosis and treatment of decompensating events requires of both medical skills and updated technical resources. The objectives of this study were to search the demographic profile of hospitalized cirrhotic patients in a group of Latin American hospitals and the availability of expertise/facilities for the diagnosis and therapy of decompensation episodes. Methods: A cross sectional, multicenter survey of hospitalized cirrhotic patients. Results: 377 patients, (62% males; 58 ± 11 years) (BMI > 25, 57%; diabetes 32%) were hospitalized at 65 centers (63 urbans; 57 academically affiliated) in 13 countries on the survey date. Main admission causes were ascites, gastrointestinal bleeding, hepatic encephalopathy and spontaneous bacterial peritonitis/other infections. Most prevalent etiologies were alcohol-related (AR) (40%); non-alcoholic-steatohepatitis (NASH) (23%), hepatitis C virus infection (HCV) (7%) and autoimmune hepatitis (AIH) (6%). The most frequent concurrent etiologies were AR + NASH. Expertise and resources in every analyzed issue were highly available among participating centers, mostly accomplishing valid guidelines. However, availability of these facilities was significantly higher at institutions located in areas with population > 500,000 (n = 45) and in those having a higher complexity level (Gastrointestinal, Liver and Internal Medicine Departments at the same hospital (n = 22). Conclusions: The epidemiological etiologic profile in hospitalized, decompensated cirrhotic patients in Latin America is similar to main contemporary emergent agents worldwide. Medical and technical resources are highly available, mostly at great population urban areas and high complexity medical centers. Main diagnostic and therapeutic approaches accomplish current guidelines recommendations