12 April 2018, Paris, France: A worldwide study initiated to investigate the epidemiology and outcomes of bacterial infections in hospitalized patients with liver cirrhosis has reported a prevalence of multi-drug-resistant (MDR) bacteria of 34% and significant regional differences in the risk of developing a multi-drug-resistant infection. Research teams from 46 centres across the world collaborated in this international study, which was promoted by the International Club of Ascites, the final results of which were presented today at The International Liver Congress™ 2018 in Paris, France.
Bacterial infections are common in patients with cirrhosis and are one of the most important causes of liver-related complications, progression of liver failure, and mortality in these patients.1 Multi-drug-resistant bacteria have emerged as a significant challenge in many countries,2 and infections caused by these bacteria are associated with a particularly poor prognosis in patients with cirrhosis.3
The study presented today in Paris included 1,302 hospitalized patients with cirrhosis and bacterial or fungal infections in North or South America (25%), Asia (32%) and Europe (43%). The most common infections identified were spontaneous bacterial peritonitis (SBP; 27%), urinary tract infection (UTI; 22%), and pneumonia (19%). A total of 740 patients (57%) had at least one positive culture and 959 microorganisms were isolated (58% gram negative, 38% gram positive, 4% fungi).
The global prevalence of MDR bacteria was reported to be 34% (95% CI 31, 37%), with the likelihood of having such an infection being higher in Asia (OR 2.79; p=0.017), particularly India (OR 7.94; p<0.001) or in South America (OR 2.23; p=0.053). In addition, use of antibiotics in the 3 months prior to hospitalization (OR 1.92; p=0.001), the category of infection (nosocomial: OR 2.65; p<0.001; healthcare-associated: OR 1.62; p=0.032) and the site of infection (pneumonia: OR 3.20; p<0.001; UTI: OR 2.48; p<0.001; skin and soft tissue: OR 2.92; p=0.004) were associated with an increased risk.
'Not surprisingly, we found a significantly lower rate of response to empirical antibiotic treatment in patients with infections caused by MDR bacteria compared with those due to non-MDR bacteria', said the authors of the presentation. 'We also saw a significantly higher incidence of shock and new organ failures, and a higher rate of in-hospital mortality among those with MDR bacterial infections'.
In light of these findings, they also stressed the urgent need to develop different empirical antibiotic strategies across different parts of the world. 'In the meantime, while we wait for new antibiotics to be developed, we must focus our efforts on reducing the spread of MDR bacteria among our patients with cirrhosis'.
'The finding that over one in three of bacterial infections occurring in hospitalized patients with cirrhosis are induced by multidrug resistance microorganisms is very worrisome', said Prof. Annalisa Berzigotti from the University of Bern, Switzerland, and EASL Governing Board Member. 'Awareness of this increasing problem is key in implementing the correct management procedures, such as the enhancement of hygiene measures (e.g. contact isolation), and to guide the choice of empiric antibiotic therapy in patients with a high risk of infection by MDR bacteria'.
About The International Liver Congress™
This annual congress is the biggest event in the EASL calendar, attracting scientific and medical experts from around the world to learn about the latest in liver research. Attending specialists present, share, debate and conclude on the latest science and research in hepatology, working to enhance the treatment and management of liver disease in clinical practice. This year, the congress is expected to attract approximately 10,000 delegates from all corners of the globe. The International Liver Congress™ 2018 will take place from 11¬-15 April 2018 at the Paris Convention Centre, Paris, France.
About The European Association for the Study of the Liver (EASL)
Since its foundation in 1966, this not-for-profit organization has grown to over 4,000 members from all over the world, including many of the leading hepatologists in Europe and beyond. EASL is the leading liver association in Europe, having evolved into a major European association with international influence, and with an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy.
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Onsite location reference
Session title: General session I and opening ceremony
Time, date and location of session: 12. April 2018, 02:00 PM - 02:15 PM, Main Plenary
Presenter: Salvatore Piano, Italy
Abstract: Epidemiology, predictors and outcomes of multi drug resistant bacterial infections in patients with cirrhosis across the world. Final results of the "Global study" (4005)
14. Jalan R, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol. 2014;60(6):1310-24.
15. Acevedo J. Multiresistant bacterial infections in liver cirrhosis: clinical impact and new empirical antibiotic treatment policies. World J Hepatol. 2015;7(7):916-21.
16. Salerno F, et al. The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study. Liver Int. 2017;37(1):71-9.