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Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide

(2019) GASTROENTEROLOGY. 156(5). p.1368-1380
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Abstract
BACKGROUND & AIMS: Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis. METHODS: We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge. RESULTS: The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%-37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival. CONCLUSIONS: In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.
Keywords
CHRONIC LIVER-FAILURE, HEALTH-CARE, RISK-FACTORS, MANAGEMENT, PERITONITIS, PREVALENCE, MORTALITY, DIAGNOSIS, SURVIVAL, SEPSIS, Global, Resistance, Sepsis, Stewardship

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MLA
Piano, Salvatore, et al. “Epidemiology and Effects of Bacterial Infections in Patients with Cirrhosis Worldwide.” GASTROENTEROLOGY, vol. 156, no. 5, 2019, pp. 1368–80.
APA
Piano, S., Singh, V., Caraceni, P., Maiwall, R., Alessandria, C., Fernandez, J., … Zaccherini, G. (2019). Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide. GASTROENTEROLOGY, 156(5), 1368–1380.
Chicago author-date
Piano, Salvatore, Virendra Singh, Paolo Caraceni, Rakhi Maiwall, Carlo Alessandria, Javier Fernandez, Elza Cotrim Soares, et al. 2019. “Epidemiology and Effects of Bacterial Infections in Patients with Cirrhosis Worldwide.” GASTROENTEROLOGY 156 (5): 1368–80.
Chicago author-date (all authors)
Piano, Salvatore, Virendra Singh, Paolo Caraceni, Rakhi Maiwall, Carlo Alessandria, Javier Fernandez, Elza Cotrim Soares, Dong Joon Kim, Sung Eun Kim, Monica Marino, Julio Vorobioff, Rita de Cassia Ribeiro Barea, Manuela Merli, Laure Elkrief, Victor Vargas, Aleksander Krag, Shivaram Prasad Singh, Laurentius Adrianto Lesmana, Claudio Toledo, Sebastian Marciano, Xavier Verhelst, Florence Wong, Nicolas Intagliata, Liane Rabinowich, Luis Colombato, Sang Gyune Kim, Alexander Gerbes, Francois Durand, Juan Pablo Roblero, Kalyan Ram Bhamidimarri, Thomas D Boyer, Marina Maevskaya, Eduardo Fassio, Hyoung Su Kim, Jae Seok Hwang, Pere Gines, Adrian Gadano, Shiv Kumar Sarin, Paolo Angeli, Michele Bartoletti, Carlos Brodersen, Tony Bruns, Robert A de Man, Annette Dam Fialla, Carmine Gambino, Vikas Gautam, Marcos Girala, Adria Juanola, Jeong Han Kim, Tae Hun Kim, Pramod Kumar, Barbara Lattanzi, Tae Hee Lee, Cosmas A Rinaldi Lesmana, Richard Moreau, Preetam Nath, Gustavo Navarro, Ji-Won Park, Gisela Pinero, Nikolaos T Pyrsopoulos, Sophie Restellini, Gustavo Romero, Marco Sacco, Tiago Seva-Pereira, Macarena Simon-Talero, Do Seon Song, Ki Tae Suk, Hans Van Vlierberghe, Sun Young Yim, Eileen Laurel Yoon, and Giacomo Zaccherini. 2019. “Epidemiology and Effects of Bacterial Infections in Patients with Cirrhosis Worldwide.” GASTROENTEROLOGY 156 (5): 1368–1380.
Vancouver
1.
Piano S, Singh V, Caraceni P, Maiwall R, Alessandria C, Fernandez J, et al. Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide. GASTROENTEROLOGY. 2019;156(5):1368–80.
IEEE
[1]
S. Piano et al., “Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide,” GASTROENTEROLOGY, vol. 156, no. 5, pp. 1368–1380, 2019.
@article{8653992,
  abstract     = {{BACKGROUND & AIMS: Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis.
METHODS: We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge.
RESULTS: The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%-37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival.
CONCLUSIONS: In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.}},
  author       = {{Piano, Salvatore and Singh, Virendra and Caraceni, Paolo and Maiwall, Rakhi and Alessandria, Carlo and Fernandez, Javier and Soares, Elza Cotrim and Kim, Dong Joon and Kim, Sung Eun and Marino, Monica and Vorobioff, Julio and Ribeiro Barea, Rita de Cassia and Merli, Manuela and Elkrief, Laure and Vargas, Victor and Krag, Aleksander and Singh, Shivaram Prasad and Lesmana, Laurentius Adrianto and Toledo, Claudio and Marciano, Sebastian and Verhelst, Xavier and Wong, Florence and Intagliata, Nicolas and Rabinowich, Liane and Colombato, Luis and Kim, Sang Gyune and Gerbes, Alexander and Durand, Francois and Pablo Roblero, Juan and Bhamidimarri, Kalyan Ram and Boyer, Thomas D and Maevskaya, Marina and Fassio, Eduardo and Kim, Hyoung Su and Hwang, Jae Seok and Gines, Pere and Gadano, Adrian and Sarin, Shiv Kumar and Angeli, Paolo and Bartoletti, Michele and Brodersen, Carlos and Bruns, Tony and de Man, Robert A and Fialla, Annette Dam and Gambino, Carmine and Gautam, Vikas and Girala, Marcos and Juanola, Adria and Kim, Jeong Han and Kim, Tae Hun and Kumar, Pramod and Lattanzi, Barbara and Lee, Tae Hee and Lesmana, Cosmas A Rinaldi and Moreau, Richard and Nath, Preetam and Navarro, Gustavo and Park, Ji-Won and Pinero, Gisela and Pyrsopoulos, Nikolaos T and Restellini, Sophie and Romero, Gustavo and Sacco, Marco and Seva-Pereira, Tiago and Simon-Talero, Macarena and Song, Do Seon and Suk, Ki Tae and Van Vlierberghe, Hans and Yim, Sun Young and Yoon, Eileen Laurel and Zaccherini, Giacomo}},
  issn         = {{0016-5085}},
  journal      = {{GASTROENTEROLOGY}},
  keywords     = {{CHRONIC LIVER-FAILURE,HEALTH-CARE,RISK-FACTORS,MANAGEMENT,PERITONITIS,PREVALENCE,MORTALITY,DIAGNOSIS,SURVIVAL,SEPSIS,Global,Resistance,Sepsis,Stewardship}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{1368--1380}},
  title        = {{Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide}},
  url          = {{http://dx.doi.org/10.1053/j.gastro.2018.12.005}},
  volume       = {{156}},
  year         = {{2019}},
}

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