@article{3470c0f14f394323b0c2a44bd6bb0baa,
title = "Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide",
abstract = "Background & Aims: Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis. Methods: We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge. Results: The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%–37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival. Conclusions: In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.",
keywords = "Global, Resistance, Sepsis, Stewardship",
author = "{International Club of Ascites Global Study Group} and Salvatore Piano and Virendra Singh and Paolo Caraceni and Rakhi Maiwall and Carlo Alessandria and Javier Fernandez and Soares, {Elza Cotrim} and Kim, {Dong Joon} and Kim, {Sung Eun} and Monica Marino and Julio Vorobioff and Barea, {Rita de Cassia Ribeiro} and Manuela Merli and Laure Elkrief and Victor Vargas and Aleksander Krag and Singh, {Shivaram Prasad} and Lesmana, {Laurentius Adrianto} and Claudio Toledo and Sebastian Marciano and Xavier Verhelst and Florence Wong and Nicolas Intagliata and Liane Rabinowich and Luis Colombato and Kim, {Sang Gyune} and Alexander Gerbes and Francois Durand and Roblero, {Juan Pablo} and Bhamidimarri, {Kalyan Ram} and Boyer, {Thomas D.} and Marina Maevskaya and Eduardo Fassio and Kim, {Hyoung Su} and Hwang, {Jae Seok} and Pere Gines and Adrian Gadano and Sarin, {Shiv Kumar} and Paolo Angeli and Michele Bartoletti and Carlos Brodersen and Tony Bruns and {de Man}, {Robert A.} and Fialla, {Annette Dam} and Carmine Gambino and Vikas Gautam and Marcos Girala and Adria Juanola and Kim, {Jeong Han} and Kim, {Tae Hun}",
note = "Funding Information: Funding This study was supported by a grant from the Italian Ministry of Education,University and Research ( DOR1678487/16 ). PG is recipient of an ICREA Academia award. Funding Information: Funding This study was supported by a grant from the Italian Ministry of Education,University and Research (DOR1678487/16). PG is recipient of an ICREA Academia award. Funding This study was supported by a grant from the Italian Ministry of Education,University and Research (DOR1678487/16). PG is recipient of an ICREA Academia award. We dedicate this paper to Dr Thomas D. Boyer in recognition of his outstanding value as hepatologist, mentor, and scientist. May he rest in peace. Collaborators of the International Club of Ascites Global Study Group are presented in the Appendix. Author contributions: Paolo Angeli, Shiv Kumar Sarin, Virendra Singh, Adrian Gadano, and Aleksander Krag devised the study. Paolo Angeli, Shiv Kumar Sarin, Adrian Gadano, Aleksander Krag, Salvatore Piano, Javier Fernandez, and Thomas D. Boyer designed the study. Salvatore Piano, Virendra Singh, Paolo Caraceni, Rakhi Maiwall, Carlo Alessandria, Javier Fernandez, Elza Cotrim Soares, Dong Joon Kim, Sung Eun Kim, Monica Marino, Julio Vorobioff, Rita de Cassia Ribeiro Barea, Manuela Merli, Laure Elkrief, Victor Vargas, Aleksander Krag, Shivaram Prasad Singh, Laurentius Adrianto Lesmana, Claudio Toledo, Sebastian Marciano, Xavier Verhelst, Florence Wong, Nicolas Intagliata, Liane Rabinowich, Luis Colombato, Sang Gyune Kim, Alexander Gerbes, Francois Durand, Juan Pablo Roblero, Kalyan Ram Bhamidimarri, Thomas D. Boyer, Marina Maevskaya, Eduardo Fassio, Hyoung Su Kim, and Jae Seok Hwang enrolled patients and collected data. Salvatore Piano, Paolo Angeli, Shiv Kumar Sarin, Virendra Singh, Adrian Gadano, Aleksander Krag, and Francois Durand analyzed and interpreted the data. Salvatore Piano, Paolo Angeli, Virendra Singh, Shiv Kumar Sarin, Rakhi Maiwall, Adrian Gadano, Sebastian Marciano, Aleksander Krag, and Francois Durand drafted the manuscript. Paolo Caraceni, Carlo Alessandria, Javier Fernandez, Florence Wong, Nicolas Intagliata, and Pere Gines critically revised the manuscript for important intellectual content. Funding This study was supported by a grant from the Italian Ministry of Education,University and Research (DOR1678487/16). PG is recipient of an ICREA Academia award. Publisher Copyright: {\textcopyright} 2019 AGA Institute Copyright: Copyright 2019 Elsevier B.V., All rights reserved.",
year = "2019",
month = apr,
doi = "10.1053/j.gastro.2018.12.005",
language = "English (US)",
volume = "156",
pages = "1368--1380.e10",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "5",
}