Yonsei Med J.  2020 Feb;61(2):145-153. 10.3349/ymj.2020.61.2.145.

Culture-Positive Spontaneous Ascitic Infection in Patients with Acute Decompensated Cirrhosis: Multidrug-Resistant Pathogens and Antibiotic Strategies

• Liu J
• Gao Y
• Wang X
• Qian Z
• Chen J
• Huang Y
• Meng Z
• Lu X
• Deng G
• Liu F
• Zhang Z
• Li H
• Zheng X

• KMID: 2468489
• DOI: http://doi.org/10.3349/ymj.2020.61.2.145

Abstract

PURPOSE
This study investigated multidrug-resistant (MDR) pathogens and antibiotic strategies of culture-positive spontaneous ascitic infection (SAI) in patients with acute decompensated cirrhosis.
MATERIALS AND METHODS
We retrospectively analyzed 432 acute decompensated cirrhotic patients with culture-positive SAI from 11 teaching hospitals in China (January 2012 to May 2018). A Cox proportional hazards model analysis was conducted to identify independent predictors of 28-day mortality.
RESULTS
A total of 455 strains were isolated from 432 ascitic culture samples. Gram-negative bacteria (GNB), gram-positive bacteria (GPB), and fungi caused 52.3, 45.5, and 2.2% of all SAI episodes, respectively. Episodes were classified as nosocomial (41.2%), healthcare-related (34.7%), and community-acquired (24.1%). Escherichia coli (13.4%) and Klebsiella pneumoniae (2.4%) were extended-spectrum β-lactamase producing isolates. The prevalence of methicillin-resistant Staphylococcus aureus was 1.1%. Ceftazidime, cefepime, aztreonam, and amikacin were recommended as first-line antibiotics agents for non-MDR GNB infections; piperacillin/tazobactam and carbapenems for MDR GNB in community-acquired and healthcare-related or nosocomial infections, respectively; and vancomycin or linezolid for GPB infections, regardless of drug-resistance status. Multivariate analysis revealed days of hospital stay before SAI, upper gastrointestinal bleeding, white blood cell count, alanine aminotransferase, serum creatinine concentration, total bilirubin, and international normalized ratio as key independent predictors of 28-day mortality.
CONCLUSION
MDR pathogens and antibiotic strategies were identified in patients with acute decompensated cirrhosis with culture-positive SAI, which may help optimize therapy and improve clinical outcomes.

Keyword

Spontaneous ascitic infection; cirrhosis; multidrug-resistant; antibiotic strategies; risk factors

MeSH Terms

Alanine Transaminase
Amikacin
Anti-Bacterial Agents
Aztreonam
Bilirubin
Carbapenems
Ceftazidime
China
Creatinine
Cross Infection
Escherichia coli
Fibrosis*
Fungi
Gram-Negative Bacteria
Gram-Positive Bacteria
Hemorrhage
Hospitals, Teaching
Humans
International Normalized Ratio
Klebsiella pneumoniae
Length of Stay
Leukocyte Count
Linezolid
Methicillin-Resistant Staphylococcus aureus
Mortality
Multivariate Analysis
Prevalence
Proportional Hazards Models
Retrospective Studies
Risk Factors
Vancomycin
Alanine Transaminase
Amikacin
Anti-Bacterial Agents
Aztreonam
Bilirubin
Carbapenems
Ceftazidime
Creatinine
Linezolid
Vancomycin

Figure

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  Fig. 1 Flowchart of patient enrollment in this study.

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  Fig. 2 Trends in microorganism and multidrug-resistant isolates distributions between 2012–2015 and 2016–2018. ESBL, extended-spectrum β-lactamase; FQR, fluoroquinolone-resistant; MRSA, methicillin-resistant Staphylococcus aureus; PRSV, penicillin-resistant Streptococcus viridans.

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