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Culture-Positive Spontaneous Ascitic Infection in Patients with Acute Decompensated Cirrhosis: Multidrug-Resistant Pathogens and Antibiotic Strategies

Yonsei Medical Journal 2020년 61권 2호 p.145 ~ 153
 ( Liu Jing ) - CATCH-LIFE Chinese Acute-on-Chronic Liver Failure Consortium

 ( Gao Yanhang ) - CATCH-LIFE Chinese Acute-on-Chronic Liver Failure Consortium
 ( Wang Xianbo ) - CATCH-LIFE Chinese Acute-on-Chronic Liver Failure Consortium
 ( Qian Zhiping ) - CATCH-LIFE Chinese Acute-on-Chronic Liver Failure Consortium
 ( Chen Jinjun ) - CATCH-LIFE Chinese Acute-on-Chronic Liver Failure Consortium
 ( Huang Yan ) - CATCH-LIFE Chinese Acute-on-Chronic Liver Failure Consortium
 ( Meng Zhongji ) - CATCH-LIFE Chinese Acute-on-Chronic Liver Failure Consortium
 ( Lu Xiaobo ) - CATCH-LIFE Chinese Acute-on-Chronic Liver Failure Consortium
 ( Deng Guohong ) - CATCH-LIFE Chinese Acute-on-Chronic Liver Failure Consortium
 ( Liu Feng ) - CATCH-LIFE Chinese Acute-on-Chronic Liver Failure Consortium
 ( Zhang Zhiguo ) - Huazhong University of Science and Technology Tongji Medical College School of Medicine and Health Management
 ( Li Hai ) - CATCH-LIFE Chinese Acute-on-Chronic Liver Failure Consortium
 ( Zheng Xin ) - CATCH-LIFE Chinese Acute-on-Chronic Liver Failure Consortium

Abstract


Purpose: This study investigated multidrug-resistant (MDR) pathogens and antibiotic strategies of culture-positive spontaneous ascitic infection (SAI) in patients with acute decompensated cirrhosis.

Materials and Methods: We retrospectively analyzed 432 acute decompensated cirrhotic patients with culture-positive SAI from 11 teaching hospitals in China (January 2012 to May 2018). A Cox proportional hazards model analysis was conducted to identify independent predictors of 28-day mortality.

Results: A total of 455 strains were isolated from 432 ascitic culture samples. Gram-negative bacteria (GNB), gram-positive bacteria (GPB), and fungi caused 52.3, 45.5, and 2.2% of all SAI episodes, respectively. Episodes were classified as nosocomial (41.2%), healthcare-related (34.7%), and community-acquired (24.1%). Escherichia coli (13.4%) and Klebsiella pneumoniae (2.4%) were extended-spectrum β-lactamase producing isolates. The prevalence of methicillin-resistant Staphylococcus aureus was 1.1%. Ceftazidime, cefepime, aztreonam, and amikacin were recommended as first-line antibiotics agents for non-MDR GNB infections; piperacillin/tazobactam and carbapenems for MDR GNB in community-acquired and healthcare-related or nosocomial infections, respectively; and vancomycin or linezolid for GPB infections, regardless of drug-resistance status. Multivariate analysis revealed days of hospital stay before SAI, upper gastrointestinal bleeding, white blood cell count, alanine aminotransferase, serum creatinine concentration, total bilirubin, and international normalized ratio as key independent predictors of 28-day mortality.

Conclusion: MDR pathogens and antibiotic strategies were identified in patients with acute decompensated cirrhosis with culture-positive SAI, which may help optimize therapy and improve clinical outcomes.

키워드

Spontaneous ascitic infection; cirrhosis; multidrug-resistant; antibiotic strategies; risk factors
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