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Erschienen in: European Journal of Clinical Microbiology & Infectious Diseases 1/2018

30.09.2017 | Original Article

Intestinal colonization with resistant bacteria: a prognostic marker of mortality in decompensated cirrhosis

verfasst von: S. Pouriki, G. Vrioni, H. Sambatakou, A. Alexopoulou, L. Vasilieva, I. Mani, A. Tsakris, S. P. Dourakis

Erschienen in: European Journal of Clinical Microbiology & Infectious Diseases | Ausgabe 1/2018

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Abstract

Infections due to drug-resistant (DR) bacteria are increasingly recognized as an emerging problem worldwide. Asymptomatically colonized patients may contribute to the reservoir in the hospital setting, causing both horizontal transmission and endogenous infections. We aimed to evaluate the prevalence of intestinal colonization with DR bacteria on subsequent clinical infection development and prognosis in patients with decompensated cirrhosis. One hundred seven patients without infection at baseline were screened and prospectively followed-up for 3 months. Among the patients screened, DR bacteria were isolated in 47 (43.9%), 14 colonized with multidrug- (MDR) and 33 with extensively drug (XDR)-resistant bacteria or a mixture of MDR/XDR bacteria. Severity of liver disease and demographic characteristics were similar among groups. The 20 (42.6%) with DR vs 14 (23.3%) without had hepatic encephalopathy and/or spontaneous bacterial peritonitis episodes over the past 6 months (p = 0.034). One third of both DR and non-DR groups developed infection during follow-up but in only 7 and 5, respectively, the infection was microbiologically documented. In a 3-month-follow-up period, mortality was higher in patients colonized with XDR compared to those without (log rank p = 0.027). In multivariate analysis, colonization with XDR bacteria [HR = 1.074, (CI:1.024–1.126), p = 0.003] and MELD score [HR = 2.579 (1.109–5.996), p = 0.028] were independently associated with low survival. Asymptomatic GI colonization with DR bacteria is a risk factor for increased mortality in decompensated cirrhosis. Frequent hospitalizations for complications of the underlying disease and selective pressure induced by the use of antimicrobials are probably the main determinants.
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Metadaten
Titel
Intestinal colonization with resistant bacteria: a prognostic marker of mortality in decompensated cirrhosis
verfasst von
S. Pouriki
G. Vrioni
H. Sambatakou
A. Alexopoulou
L. Vasilieva
I. Mani
A. Tsakris
S. P. Dourakis
Publikationsdatum
30.09.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Clinical Microbiology & Infectious Diseases / Ausgabe 1/2018
Print ISSN: 0934-9723
Elektronische ISSN: 1435-4373
DOI
https://doi.org/10.1007/s10096-017-3110-9

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