Division of General Medicine C, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Liver Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
PLoS One. 2023 Feb 16;18(2):e0281813. doi: 10.1371/journal.pone.0281813. eCollection 2023.
Bacterial infections represent a major cause of morbidity and mortality in cirrhotic patients. Our aim was to assess the incidence of bacterial infections, in particular due to multidrug-resistant organisms (MDROs) before and after the introduction of the antimicrobial stewardship program, "Stewardship Antimicrobial in VErona" (SAVE). In addition, we also analysed the liver complications and the crude mortality during the whole follow up.
We analysed 229 cirrhotic subjects without previous hospitalization for infections enrolled at the University Verona Hospital from 2017 to 2019 and followed up until December 2021 (mean follow-up 42.7 months).
101 infections were recorded and 31.7% were recurrent. The most frequent were sepsis (24.7%), pneumonia (19.8%), spontaneous bacterial peritonitis (17.8%). 14.9% of infections were sustained by MDROs. Liver complications occurred more frequently in infected patients, and in case of MDROs infections with a significantly higher MELD and Child-Pugh score. In Cox regression analysis, mortality was associated with age, diabetes and bacterial infections episodes (OR 3.30, CI 95%: (1.63-6.70). Despite an increase in total infections over the past three years, a decrease in the incidence rate in MDROs infections was documented concurrently with the introduction of SAVE (IRD 28.6; 95% CI: 4.6-52.5, p = 0.02).
Our study confirms the burden of bacterial infections in cirrhotic patients, especially MDROs, and the strong interconnection with liver complications. The introduction of SAVE decreased MDROs infections. Cirrhotic patients require a closer clinical surveillance to identify colonized patients and avoid the horizontal spread of MDROs in this setting.
细菌感染是肝硬化患者发病率和死亡率的主要原因。我们旨在评估引入抗菌药物管理项目“VErona 抗菌药物管理”（SAVE）前后细菌感染，特别是多重耐药菌（MDRO）的发生率。此外，我们还分析了整个随访期间的肝脏并发症和总死亡率。
我们分析了 2017 年至 2019 年在维罗纳大学医院就诊且无既往感染住院史的 229 例肝硬化患者，并随访至 2021 年 12 月（平均随访 42.7 个月）。
共记录了 101 例感染，其中 31.7%为复发感染。最常见的感染是败血症（24.7%）、肺炎（19.8%）、自发性细菌性腹膜炎（17.8%）。14.9%的感染由 MDRO 引起。感染患者更易发生肝脏并发症，且 MDRO 感染的 MELD 和 Child-Pugh 评分显著更高。在 Cox 回归分析中，死亡率与年龄、糖尿病和细菌感染发作有关（OR 3.30，95%CI：1.63-6.70）。尽管过去三年总感染人数有所增加，但随着 SAVE 的引入，MDRO 感染的发病率却有所下降（发病率下降 28.6%；95%CI：4.6-52.5，p = 0.02）。
我们的研究证实了肝硬化患者，尤其是 MDRO 感染的细菌感染负担以及与肝脏并发症的密切关联。引入 SAVE 可减少 MDRO 感染。肝硬化患者需要更密切的临床监测，以识别定植患者并避免 MDRO 在该环境中的横向传播。
