P-6 PATTERNS OF ANTIBIOTIC RESISTANCE IN PATIENTS WITH CIRRHOSIS AND SPONTANEOUS BACTERIAL INFECTIONS: ANALYSES OF THE MULTICENTER STUDY FROM ARGENTINA AND URUGUAY

• Published in: Annals of hepatology 2023-03, Vol.28, p.100910, Article 100910
• Main Authors: Marciano, Sebastián, Acevedo, Maria Nelly Gutierrez, Barbero, Sabrina, Notari, Lorena del Carmen, Agozino, Marina, Fernandez, Jose Luis, Anders, Maria Margarita, Grigera, Nadia, Antinucci, Florencia, Ganem, Orlando Federico Orozco, Murga, Maria Dolores, Perez, Daniela, Palazzo, Ana, Rejtman, Liria Martinez, Duarte, Ivonne Giselle, Vorobioff, Julio, Trevizan, Victoria, Bulaty, Sofía, Bessone, Fernando, Valverde, Marcelo, Elizondo, Martín, Bosia, José Daniel, Borzi, Silvia Mabel, Stieben, Teodoro E., Masola, Adriano, Ferretti, Sebastian Eduardo, Arufe, Diego, Demirdjian, Ezequiel, Raffa, Maria Pia, Peralta, Mirta, Fainboim, Hugo Alberto, Vazquez, Cintia Elizabet, Ruiz, Pablo, Martínez, José Emanuel, Heffner, Leandro Alfredo, Odzak, Andrea, Dirchwolf, Melisa, Smud, Astrid, Mendizabal, Manuel, Bellizzi, Carla, Martinez, Ana, Tomatis, Jesica, Bruno, Andres, Ramos, Agñel, Pages, Josefina, Tevez, Silvina, Giunta, Diego, Gadano, Adrian
• Format: Article
• Language: English
• ISSN: 1665-2681; 2659-5982
• DOI: 10.1016/j.aohep.2023.100910

Selecting an empiric antibiotic treatment in patients with cirrhosis and spontaneous bacterial infections is challenging. It is of paramount importance to have local epidemiological data to maximize pathogen coverage while minimizing the unnecessary use of broad-spectrum antibiotics. This study aimed to describe the patterns of antibiotic resistance of spontaneous bacterial infections according to the site of acquisition. Analysis of the multicenter prospective cohort study of cirrhotic patients with bacterial infections in Argentina and Uruguay (NCT03919032). Only culture-positive spontaneous infections were included in this study: spontaneous bacterial peritonitis (SBP), spontaneous bacterial empyema (SBE), and spontaneous bacteremia (SB). We estimated the proportion of infections that were sensitive to various antibiotics according to where the infection was acquired: community-acquired (CA), healthcare-associated (HCA), or nosocomial (NOS). Approximately 80% coverage is advisable for empiric treatments in stable patients and 90% for critically-ill patients. The main cohort included 472 patients, of whom 97 presented culture-positive spontaneous infections and were included: with 57 (59%) SBP, 34 (35%) SB, and 4 (6%) SBE. Regarding the site of acquisition, 43% were CA, 36% NOS, and 21% HCA. Gram-positive and negative bacteria were found in 53% and 47% of the infections. The most frequent isolations were Streptococcus spp (26%), E coli (20), K pneumonia (15%), S Aureus (10%), E. faecium (6%) and E. faecalis (4%). Multidrug-resistant organisms (MDROs) were isolated in 35% of the patients. As shown in the table, cefepime and ceftriaxone offer the most rational coverage for CA and HCA infections, and imipenem or meropenem for NOS infections. However, in critically-ill patients, broader-spectrum antibiotics are needed to achieve a coverage closer to 90% (table). We present, for the first time in our region, evidence-based recommendations for the empirical treatment of spontaneous bacterial infections. Prior colonization and/or infections by MDROs might refine even more the antibiotic selection and should be explored.