Feldman Shani, Russo Alessandro, Ceccarelli Giancarlo, Borrazzo Cristian, Madge Chiara, Venditti Mario, Merli Manuela
Division of Gastroenterology, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale Dell'Università 37, 00185 Rome, Italy.
Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Viale Dell'Università 37, 00185, Rome, Italy.
J Clin Exp Hepatol. 2022 Sep-Oct;12(5):1293-1300. doi: 10.1016/j.jceh.2022.04.016. Epub 2022 Apr 21.
Carbapenem-resistant (CRKP) infections in patients with cirrhosis represent a significant therapeutic challenge as they are associated with poor outcomes due to high rates of treatment failure, and frequently induce liver decompensation.
To evaluate treatment failure and in-hospital mortality in two cohorts of patients with cirrhosis and with CRKP infections treated with antibiotic regimens including or excluding Ceftazidime-avibactam.
Data from hospitalized patients with liver cirrhosis and CRKP infections were extracted and retrospectively analyzed.
During the study period, 39 cirrhotic patients with confirmed invasive CRKP infections were enrolled. Overall, the median age was 60 years with a median MELD score of 16 points. Urinary tract infections were diagnosed in 46%, followed by pneumonia in 23%, and primary bacteremia in 18% of patients. Treatment failure was reported in 10 patients (26%), while in-hospital mortality in 15 patients (38%). A monotherapy was used in 8 patients (20.5%), while a combination therapy was required in 31 patients (79.5%). Ceftazidime-avibactam therapy was associated with lower rates of treatment failure (7% vs. 38%, = 0.032) independent of severity of liver disease (Child Class) and mono or combination antibiotic therapy. Acute kidney injury, hepatorenal syndrome, and acute-on-chronic liver failure were the consequences more frequently observed in patients with treatment failure. In-hospital mortality was associated with treatment failure, and Ceftazidime-avibactam therapy improved in-hospital survival (log rank test: = 0.035) adjusted for Child class and mono or combination therapy.
Treatment including ceftazidime-avibactam was associated with a lower rate of treatment failure in cirrhotic patients with CRKP infections. Considering the favorable efficacy and outcomes of ceftazidime-avibactam, this drug should be considered for the treatment of these severe infections in patients with liver cirrhosis, though further investigation is required.
肝硬化患者的耐碳青霉烯类肺炎克雷伯菌（CRKP）感染是一项重大的治疗挑战，因为治疗失败率高，常导致肝功能失代偿，与不良预后相关。
评估两组接受含或不含头孢他啶-阿维巴坦的抗生素方案治疗的肝硬化合并CRKP感染患者的治疗失败率和院内死亡率。
提取并回顾性分析肝硬化合并CRKP感染住院患者的数据。
在研究期间，纳入了39例确诊为侵袭性CRKP感染的肝硬化患者。总体而言，中位年龄为60岁，中位终末期肝病模型（MELD）评分为16分。46%的患者诊断为尿路感染，23%为肺炎，18%为原发性菌血症。10例患者（26%）报告治疗失败，15例患者（38%）院内死亡。8例患者（20.5%）采用单药治疗，31例患者（79.5%）需要联合治疗。头孢他啶-阿维巴坦治疗与较低的治疗失败率相关（7%对38%，P = 0.032），与肝病严重程度（Child分级）以及单药或联合抗生素治疗无关。急性肾损伤、肝肾综合征和急性慢性肝衰竭是治疗失败患者中更常观察到的后果。院内死亡率与治疗失败相关，经Child分级和单药或联合治疗校正后，头孢他啶-阿维巴坦治疗改善了院内生存率（对数秩检验：P = 0.035）。
含头孢他啶-阿维巴坦的治疗与肝硬化合并CRKP感染患者较低的治疗失败率相关。考虑到头孢他啶-阿维巴坦良好的疗效和结局，尽管需要进一步研究，但对于肝硬化患者的这些严重感染，应考虑使用该药物进行治疗。
