Clinical impact of multidrug-resistant bacterial infections in patients with cirrhosis

Figures & data

Figure 1. Flow chart of patients included in the study.

MDROs: Multidrug-resistant organisms.

Table 1. Comparison of group characteristics according to the presence or absence of multidrug-resistant organisms.

Variable	Total isolates (N = 115)	MDROs (N = 44)	No MDROs (N = 71)	p-value
Age, years, mean (SD)	63.9 (12.1)	64.4 (11.6)	63.6 (12.4)	0.724
Male, N (%)	69 (60)	27 (61.4)	42 (59.1)	0.486
Comorbidities
Diabetes, N (%)	56 (48.7)	25 (56.8)	31 (43.7)	0.119
arterial hypertension, N (%)	41 (35.6)	17 (38.6)	24 (33.8)	0.371
coronary artery disease, N (%)	11 (9.6)	5 (11.3)	6 (8.4)	0.417
Hypothyroidism, N (%)	9 (7.8)	4 (9)	5 (7)	0.474
Smoking, N (%)	45 (39.1)	18 (40.9)	27 (28)	0.454
Alcohol, N (%)	6 (5.2)	4 (9)	2 (2.8)	0.150
BMI, kg/m^2, mean (SD)	27.9 (5.4)	27.2 (5.3)	28.2 (5.3)	0.356
Etiology of cirrhosis:
HCV, N (%)	29 (25.2)	9 (20.4)	20 (28.2)	0.755
HBV, N (%)	21 (18.2)	8 (18.1)	13 (18.3)
NASH, N (%)	24 (20.9)	8 (18.1)	16 (22.5)
Alcohol, N (%)	6 (5.2)	4 (9)	2 (2.8)
Others, N (%)
HCC, N (%)	31 (28.7)	13 (29.5)	18 (25.3)	0.389
CSPH, N (%)	111 (96.5)	43 (97.7)	68 (95.7)	0.504
CHILD-Pugh, mean (SD)	9.5 (2.2)	10.6 (2.2)	8.9 (2)	0.001
MELD, mean (SD)	17.9 (5.8)	20.1 (5.6)	16.2 (5.3)	<0.001
MELD sodium, mean (SD)	21.7 (6.2)	25.3 (5.3)	19.43 (5.6)	<0.001
INR, mean (SD)	1.50 (0.36)	1.45 (0.32)	1.59 (0.41)	0.738
BILIRUBIN, mean (SD)	52.4 (72.3)	50.9 (42.9)	70.8 (103.3)	0.022
Fluoroquinolones prophylaxis, N (%)	10 (8.7)	5 (11.3)	5 (7)	0.318
Treatment with Rifaximin, N (%)	53 (46)	21 (47.7)	32 (45.1)	0.466
Treatment with PPI, N (%)	15 (13)	5 (11.3)	10 (14.1)	0.453
Systemic Antibiotic treatment in previous 3 months, N (%)	34 (29.6)	22 (50)	12 (16.9)	0.002
MDROs isolation in previous 6 months, N (%)	5 (4.3)	2 (4.5)	3 (4.2)	0.637
Invasive procedures in the previous month, N (%)	13 (11.3)	5 (11.3)	8 (11.7)	0.606
Site of infection:
UTI, N (%)	74 (64.3)	23 (52.3)	51 (71.8)	0.108
Spontaneous bacteraemia, N (%)	28 (24.3)	13 (9.5)	15 (21.1)
SBP, N (%)	12 (10.4)	7 (15.9)	5 (7)
Types of infection:
Community-acquired, N (%)	35 (30.4)	1 (2.3)	34 (47.9)	<0.001
HCA, N (%)	60 (52.2)	31 (70.4)	29 (40.8)
Nosocomial, N (%)	20 (17.4)	12 (27.7)	8 (11.3)
Leukocytes, 10^9/l, mean (SD)	7.4 (6.8)	8.1 (6.9)	7.04 (6.8)	0.439
CRP, mg/l, mean (SD)	48.9 (48.6)	59.1 (50.5)	42.5 (46.7)	0.085
Creatinine, μmol/l, mean (SD)	129.2 (84.7)	167.6 (109.8)	105.4 (52.9)	0.001
Urea, mmol/l, mean (SD)	10.3 (7.3)	12.9 (8.6)	8.6 (5.7)	0.006

CRP: C reactive protein; CSPH: Clinically significant portal hypertension; HBV: Hepatitis B virus; HCA: Healthcare-associated; HCC: Hepatocellular carcinoma; HCV: Hepatitis C virus; MDRO: Multidrug-resistant organism; NASH: Nonalcoholic steatohepatitis; PPI: Proton pump inhibitor; SBP: Spontaneous bacterial peritonitis; SD: Standard deviation; UTI: Urinary tract infection.

Table 2. Independent risk factors of infection by multidrug-resistant organisms.

Variable	OR	95% CI	p-value
Types of infection:
HCA, N (%)	3.45	1.54–7.70	0.017
Nosocomial, N (%)	2.95	1.07–7.95	0.006
Antibiotic treatment in previous 3 months, N (%)	4.91	2.08–11.58	0.031

HCA: Healthcare-associated; OR: Odds ratio.

Table 3. Clinical impact of multidrug-resistant organisms in cirrhotic patients with acute decompensation.

Variable	Total isolates (N = 115)	MDROs (N = 44)	No MDROs (N = 71)	OR	95% CI	p-value
Failure of empiric therapy, N (%)	43 (37.4)	34 (77.3)	9 (12.7)	23.42	8.67–63.22	<0.001
Escalation of antibiotic treatment, N (%)	29 (25.2)	25 (56.8)	4 (5.7)	22.03	6.82–71.15	<0.001
Duration of antibiotic therapy, day, mean (SD)	13.8 (9.9)	18.1 (14.3)	11.8 (4.9)	–	–	0.035
Length of hospital stay, day, mean (SD)	18.8 (17.8)	23.1 (21.9)	16.3 (14.5)	–	–	0.049
AKI, N (%)	43 (37.4)	27 (61.3)	16 (22.5)	5.46	2.39–12.44	<0.001
Sepsis, N (%)	49 (42.6)	29 (65.9)	20 (28.1)	4.93	2.19–11.08	<0.001
ACLF, N (%)	66 (57.4)	33 (68.2)	33 (46.5)	3.42	1.41–8.27	0.004
Septic shock, N (%)	13 (11.3)	8 (8.2)	5 (7.1)	2.93	0.89–9.63	0.067

ACLF: Acute-on-chronic liver failure; AKI: Kidney injury; MDRO: Multidrug-resistant organism; OR: Odds ratio; SD: Standard deviation.

Table 4. Impact of multidrug-resistant organisms on short-term mortality in cirrhotic patients with acute decompensation.

Variable	Total patients with positive culture (N = 46)	Patients with MDROs (N = 18)	Patients without MDROs (N = 28)	OR	95% CI	p-value
In hospital mortality, N (%)	7 (15.2)	6 (33.3)	1 (3.5)	13.50	1.46–124.73	0.005
28 day mortality, N (%)	13 (28.3)	11 (61.1)	2 (7.1)	20.42	3.64–114.35	<0.001

MDRO: Multidrug-resistant organism; OR: Odds ratio.

Table 5. Epidemiological evolution of bacterial infection in cirrhotic patients.

Variable	Total	First 5 years (2010–2014)	Last 5 years (2015–2019)	p-value
Admissions, n (%)	518	214 (41.3)	304 (58.7)	–
Infections, n	260	88 (33.9)	172 (66.1)	<0.001
Positive-culture infections, n	115	31 (27)	84 (73)	0.025
MDROs infections, n	44	34 (77.3)	10 (22.7)	0.028

MDRO: Multidrug-resistant organism.