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©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
Published online Jan 26, 2023. doi: 10.12998/wjcc.v11.i3.534
Ref. | Study design | n | MDR infection (%) | Mortality (%) | Comments |
Piano et al[7] | Single center study | 75 | 35.0 | 86.0 | ACLF grade 2 and 3 were more frequent in MDRO infected patients |
Cassini et al[3] | Meta-analysis | 671 689 | NA | 4.9 | Estimate the incidence of infections caused by selected antibiotic-resistant bactéria in countries of the EU and EEA in 2015 |
Trebicka et al[9] | European multicenter | 376 | 18.9 | 40.8 at 28.0 d; 48.7 at 90.0 d | In 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] | Retrospective | 474 | 37.5 | - | To evaluate the resistance profile of bacteria isolated from cirrhotic patients admitted to a referral hospital in Brazil |
Trebicka et al[9] | European multicenter | 520 | 14.8 | 35.1 at 28.0 d | MDROs 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] | Retrospective | 3951 | 5.6 | 27.7 | Presence of MDR bacteria in the blood was not associated with in-hospital mortality |
No. | Risk factors for MDR infection in cirrhosis |
1 | Prior (3 mo) use of broad-spectrum antibiotics |
2 | Prior infection by MDROs (6 mo) |
3 | Nosocomial infection |
4 | Recent contact with the healthcare system |
5 | Site of infection (pneumonia, skin, and soft tissue infections) |
6 | Geographic region |
7 | Prophylactic use of antibiotics (?)/proton pump inhibitors use? |
Type of infection | Community-acquired infection | Nosocomial and HCA infection or sepsis |
SBP, spontaneous bacterial empyema and spontaneous bacteremia | Cefotaxime or Amoxicilin/clavulanic acid | Piperacillin/tazobactam or Meropenem ± Vancomycin or Daptomycin or Linezolid1 |
UTI | Fosfomycin or cotrimoxazole | Uncomplicated: Nitrofurantoin or Fosfomycin; if sepsis: Piperacillin/tazobactam or Meropenem ± Glycopeptide |
Pneumonia | Amoxicilin/clavulanic acid; Ceftriaxone + Macrolide; Levofloxacin; Moxifloxacin | Piperacillin/tazobactam or Meropenem or Ceftazidime + Ciprofloxacin; Glycopeptides or Linezolid1 should be added in patients with risk factors for MRSA2 |
Skin and soft tissue infections | Amoxicilin/clavulanic acidor ± Clindamycin | Meropenem or Piperacillin/tazobactam + Glycopeptide or Daptomycin or Linezolid1 ± Cindamycin; if necrotizing fascitis: Meropenem + Daptomycin + Clindamycin |
- Citation: Terra C, de Mattos ÂZ, Chagas MS, Torres A, Wiltgen D, Souza BM, Perez RM. Impact of multidrug resistance on the management of bacterial infections in cirrhosis. World J Clin Cases 2023; 11(3): 534-544
- URL: https://www.wjgnet.com/2307-8960/full/v11/i3/534.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v11.i3.534