Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Chinese Acute-on-Chronic Liver Failure Consortium, CATCH-LIFE, Shanghai, China.
Yonsei Med J. 2020 Feb;61(2):145-153. doi: 10.3349/ymj.2020.61.2.145.
This study investigated multidrug-resistant (MDR) pathogens and antibiotic strategies of culture-positive spontaneous ascitic infection (SAI) in patients with acute decompensated cirrhosis.
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.
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%). (13.4%) and (2.4%) were extended-spectrum β-lactamase producing isolates. The prevalence of methicillin-resistant 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.
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.
本研究旨在探讨急性失代偿性肝硬化患者自发性细菌性腹水感染（SBP）培养阳性患者的多重耐药（MDR）病原体和抗生素策略。
我们回顾性分析了中国 11 家教学医院的 432 例急性失代偿性肝硬化伴 SBP 培养阳性的患者（2012 年 1 月至 2018 年 5 月）。采用 Cox 比例风险模型分析确定 28 天死亡率的独立预测因素。
从 432 份腹水培养样本中分离出 455 株菌。革兰氏阴性菌（GNB）、革兰氏阳性菌（GPB）和真菌分别引起所有 SAI 发作的 52.3%、45.5%和 2.2%。发作分为医院获得性（41.2%）、医疗相关（34.7%）和社区获得性（24.1%）。产超广谱β-内酰胺酶的菌株分别占 13.4%和 2.4%。耐甲氧西林的 发生率为 1.1%。头孢他啶、头孢吡肟、氨曲南和阿米卡星被推荐为非 MDR GNB 感染的一线抗生素；哌拉西林/他唑巴坦和碳青霉烯类抗生素分别用于社区获得性、医疗相关或医院获得性感染中的 MDR GNB；万古霉素或利奈唑胺用于 GPB 感染，无论耐药状态如何。多变量分析显示 SAI 前住院天数、上消化道出血、白细胞计数、丙氨酸氨基转移酶、血清肌酐浓度、总胆红素和国际标准化比值是 28 天死亡率的关键独立预测因素。
鉴定了急性失代偿性肝硬化患者培养阳性 SBP 患者的 MDR 病原体和抗生素策略，这可能有助于优化治疗并改善临床结果。
