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Copyright ©The Author(s) 2023.
World J Clin Cases. Jan 26, 2023; 11(3): 534-544
Published online Jan 26, 2023. doi: 10.12998/wjcc.v11.i3.534
Table 1 Prevalence and prognosis of multidrug-resistant organisms infections in cirrhosis
Ref.
Study design
n
MDR infection (%)
Mortality (%)
Comments
Piano et al[7]Single center study7535.086.0ACLF grade 2 and 3 were more frequent in MDRO infected patients
Cassini et al[3]Meta-analysis671 689NA4.9Estimate the incidence of infections caused by selected antibiotic-resistant bactéria in countries of the EU and EEA in 2015
Trebicka et al[9]European multicenter37618.940.8 at 28.0 d; 48.7 at 90.0 dIn infection-induced ACLF, the prevalence of MDR strains was significantly higher; severe sepsis (40.7% vs 21.6%), ACLF (72.3% vs 42.0%) and 90-d mortality (48.7% vs 30.7%) were more frequent in infections caused by MDR strains compared to non-MDR strains
Costabeber et al[17]Retrospective47437.5-To evaluate the resistance profile of bacteria isolated from cirrhotic patients admitted to a referral hospital in Brazil
Trebicka et al[9]European multicenter52014.835.1 at 28.0 dMDROs were not significantly different between specific infections in the different European regions; MDROs were more frequently isolated in the ICU (23.8% vs 12.2%) and nosocomial infections (21.3% vs 8.3% and 6.6% in CA and HCA infections, respectively); MDROs were more prevalent in infections causing severe sepsis/shock (30.3% vs 12.2%) or ACLF (20.5% vs 9.4%)
Johnson et al[18]Retrospective39515.627.7Presence of MDR bacteria in the blood was not associated with in-hospital mortality
Table 2 Risk factors for multidrug-resistant infection in cirrhosis
No.
Risk factors for MDR infection in cirrhosis
1Prior (3 mo) use of broad-spectrum antibiotics
2Prior infection by MDROs (6 mo)
3Nosocomial infection
4Recent contact with the healthcare system
5Site of infection (pneumonia, skin, and soft tissue infections)
6Geographic region
7Prophylactic use of antibiotics (?)/proton pump inhibitors use?
Table 3 Recommended empirical antibiotic treatment for bacterial infection in cirrhosis
Type of infection
Community-acquired infection
Nosocomial and HCA infection or sepsis
SBP, spontaneous bacterial empyema and spontaneous bacteremiaCefotaxime or Amoxicilin/clavulanic acidPiperacillin/tazobactam or Meropenem ± Vancomycin or Daptomycin or Linezolid1
UTIFosfomycin or cotrimoxazoleUncomplicated: Nitrofurantoin or Fosfomycin; if sepsis: Piperacillin/tazobactam or Meropenem ± Glycopeptide
PneumoniaAmoxicilin/clavulanic acid; Ceftriaxone + Macrolide; Levofloxacin; MoxifloxacinPiperacillin/tazobactam or Meropenem or Ceftazidime + Ciprofloxacin; Glycopeptides or Linezolid1 should be added in patients with risk factors for MRSA2
Skin and soft tissue infectionsAmoxicilin/clavulanic acidor ± ClindamycinMeropenem or Piperacillin/tazobactam + Glycopeptide or Daptomycin or Linezolid1 ± Cindamycin; if necrotizing fascitis: Meropenem + Daptomycin + Clindamycin