Annals of Hepatology (Sep 2021)

P-68 FREQUENCY AND FACTORS ASSOCIATED WITH ANTIBIOTIC DE-ESCALATION IN PATIENTS WITH CIRRHOSIS AND BACTERIAL INFECTIONS

  • Maria Nelly Gutierrez Acevedo,
  • Sabrina Barbero,
  • Lorena del Carmen Notari,
  • Marina Agozino,
  • Jose Luis Fernandez,
  • Silvina Tevez,
  • Maria Margarita Anders,
  • Nadia Grigera,
  • Florencia Antinucci,
  • Orlando Orozco Ganem,
  • Maria Dolores Murga,
  • Daniea Perez,
  • Ana Palazzo,
  • Liria Martinez Rejtman,
  • Ivonne Giselle Duarte,
  • Julio Vorobioff,
  • Victoria Trevizan,
  • Sofía Bulaty,
  • Fernando Bessone,
  • José Daniel Bosia,
  • Silvia Mabel Borzi,
  • Teodoro E. Stieben,
  • Adriano Masola,
  • Sebastian Eduardo Ferretti,
  • Agñel Ramos,
  • Diego Arufe,
  • Ezequiel Demirdjian,
  • Maria Pia Raffa,
  • Cintia Elizabet Vazquez,
  • Pablo Ruiz,
  • José Emanuel Martínez,
  • Hugo Fainboim,
  • Mirta Peralta,
  • Leandro Alfredo Heffner,
  • Andrea Odzak,
  • Andres Bruno,
  • Melisa Dirchwolf,
  • Jesica Tomatis,
  • Astrid Smud,
  • Manuel Mendizabal,
  • Josefina Pages,
  • Carla Bellizzi,
  • Ana Martinez,
  • Diego Giunta,
  • Marcelo Valverde,
  • Martin Elizondo,
  • Ezequiel Mauro,
  • Adrian Gadano,
  • Sebastián Marciano

Journal volume & issue
Vol. 24
p. 100431

Abstract

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Background: Antibiotic de-escalation is considered a safe strategy that reduces costs and the risk of multi-drug resistant infections. However, its prevalence and associated factors in real-life practice were not reported in patients with cirrhosis in Latin-America. Aims: To estimate the prevalence of antibiotic de-escalation in patients with cirrhosis in real life-practice, and to explore its associated factors. Methods: We performed an analysis of the multicenter prospective cohort study of cirrhotic patients with bacterial infections throughout Argentina and Uruguay (clinicatrials.gov NCT03919032). Patients who died in the first 72 hs from the diagnosis of the infection were excluded. In accordance with guidelines, de-escalation was defined as changing the initially antimicrobials to a narrower spectrum regimen, or suspending one or more of the empirical antibiotics, according to culture results or to other clinical reasons, either in patients with culture-positive or culture-negative bacterial infections. We used inverse probability weighting (IPW) of having a culture-positive infection to estimate its causal effect on de-escalation. Results: We included 450 patients. Most frequent infections were SBP (30.4%), and urinary tract infection (12.9%). Overall, 243 (54%) infections were culture-positive, and 207 (46%) culture-negative. De-escalation was reported in 85 patients (18.9%: 95% CI 15%-22%) at a mean of 3.3 ± 2.4 days from treatment initiation and was more frequent in culture-positive than culture-negative infections (28.4% vs 7.7%, p< 0.001). The table shows the crude analyses of variables associated with de-escalation. Culture-positive infection was strongly and independently associated with de-escalation (ORIPW 6.08; 95% CI: 2.90-12.70; p < 0.001). Conclusions: Antibiotic de-escalation was reported in one-fifth of in-patients with cirrhosis. Given that having a culture-positive infection had a strong effect on de-escalation, efforts should be made to increase the likelihood of obtaining adequate culture samples in a timely manner.