Characteristics of bacterial infections and prevalence of multidrug-resistant bacteria in hospitalized patients with liver cirrhosis in Germany

Wolfgang Maximilian Kremer; Simon Johannes Gairing; Leonard Kaps; Esmeralda Ismail; Vasiliki Kalampoka; Max Hilscher; Maurice Michel; Ekkehard Siegel; Jörn M. Schattenberg; Peter R. Galle; Martin F. Sprinzl; Marcus-Alexander Wörns; Michael Nagel; Christian Labenz

Annals of Hepatology (Sep 2022)

Characteristics of bacterial infections and prevalence of multidrug-resistant bacteria in hospitalized patients with liver cirrhosis in Germany

Wolfgang Maximilian Kremer,
Simon Johannes Gairing,
Leonard Kaps,
Esmeralda Ismail,
Vasiliki Kalampoka,
Max Hilscher,
Maurice Michel,
Ekkehard Siegel,
Jörn M. Schattenberg,
Peter R. Galle,
Martin F. Sprinzl,
Marcus-Alexander Wörns,
Michael Nagel,
Christian Labenz

Affiliations

Wolfgang Maximilian Kremer: Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
Simon Johannes Gairing: Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
Leonard Kaps: Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
Esmeralda Ismail: Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
Vasiliki Kalampoka: Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
Max Hilscher: Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Department of Gastroenterology, Hematology, Oncology and Endocrinology, Klinikum Dortmund, Germany
Maurice Michel: Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
Ekkehard Siegel: Institute for Medical Microbiology and Hygiene, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
Jörn M. Schattenberg: Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Metabolic Liver Research Program, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
Peter R. Galle: Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
Martin F. Sprinzl: Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
Marcus-Alexander Wörns: Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Department of Gastroenterology, Hematology, Oncology and Endocrinology, Klinikum Dortmund, Germany
Michael Nagel: Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Department of Gastroenterology, Hematology, Oncology and Endocrinology, Klinikum Dortmund, Germany
Christian Labenz: Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Corresponding author at: Department of Internal Medicine I / Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55101 Mainz, Germany.

Journal volume & issue: Vol. 27, no. 5
p. 100719

Abstract

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Introduction and Objectives: Bacterial infections are associated with a dismal prognosis in patients with liver cirrhosis. Data on their prevalence and the associated pathogen spectra in Germany are scarce. This study aimed to evaluate the impact of bacterial infections on mortality in hospitalized patients with liver cirrhosis and to analyze the prevalence of multidrug-resistant (MDR) bacteria in a German tertiary care center. Patients and Methods: Consecutive, non-electively hospitalized patients with liver cirrhosis were enrolled in this study between 03/2019-06/2021. All patients underwent clinical, laboratory and microbiological testing to detect potential bacterial infections. Patients were followed for 30 days regarding the composite endpoint of death or liver transplantation (mortality). Results: In total, 239 patients were recruited (median MELD 18). Bacterial infection was detected in 81 patients (33.9%) at study inclusion. A total of 70 patients (29.3%) developed a hospital-acquired infection. When comparing community-acquired and hospital-acquired infections, the pathogen pattern shifted from a gram-negative to a more gram-positive spectrum and showed an increase of Staphylococcus spp.. MDR bacteria were detected in seven infected patients (5.8%). 34 patients reached the composite endpoint during 30-days follow-up. In multivariable logistic regression analysis, the presence of infection during hospitalization remained independently associated with higher mortality (OR 2.522, 95% CI 1.044 - 6.091, p = 0.040). Conclusions: This study demonstrates that bacterial infections are common in hospitalized patients with liver cirrhosis in Germany and are a major determinant of short-term mortality. Our data highlight the importance of regional differences in MDR bacteria and may guide physicians' decision-making regarding calculated antibiotic treatment.

Published in Annals of Hepatology

ISSN: 1665-2681 (Print); 2659-5982 (Online)
Publisher: Elsevier
Country of publisher: Spain
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine
Website: https://www.journals.elsevier.com/annals-of-hepatology

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