Trad Nouha, Mohamed Ghanem, Bizid Sondes, Abdallah Hatem Ben, Bouali Riadh, Abdelli Mohamed Nabil
Gastroenterology department, Principal Military Hospital of Instruction of Tunis, Faculty of medicine of Tunis, University Tunis El Manar Tunis, Tunisia.
Future Sci OA. 2024 May 14;10(1):FSO945. doi: 10.2144/fsoa-2023-0160. eCollection 2024.
Recently, the emergency of multidrug-resistant organisms (MDRO) has complicated the management of bacterial infections (BI) in cirrhosis. We aimed to assess their clinical impact on patients with decompensated cirrhosis. A retrospective study included consecutive cirrhotic patients hospitalized for acute decompensation (AD) between January 2010 and December 2019. A total of 518 AD admissions in 219 patients were included, with 260 BI episodes (50.2%). MDRO prevalence was 38.2% of the total isolates. Recent antibiotic use (OR = 4.91), nosocomial infection (OR = 2.95), and healthcare-associated infection (OR = 3.45) were their main risk factors. MDROs were associated with empiric treatment failure (OR = 23.42), a higher prevalence of sepsis (OR = 4.93), ACLF (OR = 3.42) and mortality. The clinical impact of MDROs was pejorative, with an increased risk of empiric treatment failure, organ failure and death.
近年来，多重耐药菌（MDRO）的出现使肝硬化患者细菌感染（BI）的管理变得复杂。我们旨在评估其对失代偿期肝硬化患者的临床影响。一项回顾性研究纳入了2010年1月至2019年12月期间因急性失代偿（AD）住院的连续性肝硬化患者。共纳入219例患者的518次AD入院病例，其中260例发生BI（50.2%）。MDRO在分离出的菌株中占比38.2%。近期使用抗生素（OR = 4.91）、医院感染（OR = 2.95）和医疗相关感染（OR = 3.45）是其主要危险因素。MDRO与经验性治疗失败（OR = 23.42）、脓毒症（OR = 4.93）、慢加急性肝衰竭（ACLF，OR = 3.42）的较高发生率及死亡率相关。MDRO的临床影响是负面的，会增加经验性治疗失败、器官衰竭和死亡的风险。
