Abstract
ObjectivesThe study aimed to investigate the clinical characteristics and antibiotic management, as well as independent indicators for survival within 30 days for Escherichia coli bloodstream infection (BSI) in liver cirrhosis.ResultsHospital-acquired BSI accounted for 60.07%, with prolonged hospital stay (P = 0.000). The prevalence of Extended Spectrum Beta-Lactamases (ESBL) producing bacteria was 48.26%, which correlated with ICU admission (P = 0.015) and high model for end-stage liver disease (MELD) score at onset of BSI (P = 0.035). Moreover, ESBL producing pathogens showed a high resistant to the common antibiotic families and 27.5% pathogens were confirmed as multidrug-resistant (MDR). MDR infection was significantly correlated with ESBL production, ICU admission, inappropriate empiric therapy, resistance to firstly selected antibiotic, and infection duration (P < 0.05 for all). In addition, appropriate empiric therapy within 48 h (HR = 2.581, 95% CI = 1.166–5.715), ICU admission (HR = 4.434, 95% CI = 2.130–8.823), HE (HR = 2.379, 95% CI = 1.115–5.073) and final MELD (HR = 1.074, 95% CI = 1.044–1.106) were independent indicators for 30-day mortality.Materials and MethodsThe clinical data were collected from 288 eligible patients, and compared according to survival status and sites of infection acquisition. Drug resistance was recorded according to ESBL. In addition, cox regression analysis model was applied to evaluate the risk factors for 30-day mortality.ConclusionsESBL production can promote resistance to antibiotics in Escherichia coli. Antibiotic regimens, ICU admission, HE and MELD score can help identify the risk individuals who will benefit from the improved therapeutic regimens.
Highlights
Liver cirrhosis is a troublesome problem for public health worldwide, with high occurrence rate and mortality [1]
The prevalence of Extended Spectrum Beta-Lactamases (ESBL) producing bacteria was 48.26%, which correlated with intensive care unit (ICU) admission (P = 0.015) and high model for end-stage liver disease (MELD) score at onset of bloodstream infection (BSI) (P = 0.035)
MDR infection was significantly correlated with ESBL production, ICU admission, inappropriate empiric therapy, resistance to firstly selected antibiotic, and infection duration (P < 0.05 for all)
Summary
Liver cirrhosis is a troublesome problem for public health worldwide, with high occurrence rate and mortality [1]. Bloodstream infection (BSI) is a serious problem in many hospitalized patients, and is referred as being primary www.oncotarget.com without obvious infection source, or secondary, arising as a complication of infection elsewhere (such as pneumonia, urinary tract, skin and soft tissues, intra-abdominal, devicerelated, etc) [10]. Two major reasons may lead to the high occurrence of BSI in cirrhosis patients: dysregulated intestinal bacterial translocation and cirrhosis associated immune dysfunction (CAID) [13]. The abnormal intestinal barrier permeability, overgrowth of small intestinal bacterial, and immune dysfunction may promote the bacteria into the bloodstream, leading to BSI [14, 15]. A populationbased cohort study indicated that BSI was a predictor for mortality in liver cirrhosis patients [17] The most common pathogens for BSI include gram-negative entericbacilli, anaerobes, and Enterococcus spp. Few studies described the specific characteristics of Escherichia coli BSI patients
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