SAT-024 - The impact of carbapenem resistance on clinical deterioration and mortality in patients with liver disease

Abstract

Background & Aims Infections with multidrug-resistant gram-negative bacteria are significantly impairing the prognosis of patients with liver disease. In particular, carbapenem resistance further narrows therapeutic options. This study investigates the impact of carbapenem-resistant gram-negative bacteria on the outcome of patients with liver disease and cirrhosis. Methods Between January 2011 and July 2015, 132 patients treated at the tertiary liver transplant center at University Hospital Frankfurt, Germany, were tested positive for carbapenem-resistant gram-negative bacteria and retrospectively analyzed in this study. Risk factors for fatal outcome were evaluated using multivariate regression analysis. Competing-risk analysis was performed on patients tested positive for Enterobacteriaceae or non-fermenting species, e.g. Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia. Subgroup analysis of cirrothic patients was performed on a matched cohort of cirrhotic patients, comparable MELD and tested negative for carbapenem-resistant gram-negative bacteria. Results 97 (73.5%) and 35 (26.5%) patients were infected or colonized with carbapenem-resistant gram-negative bacteria, respectively. Within the observation period, 61/132 (46.2%) patients died, with sepsis being the leading cause (38/61, 62.3%). Decompensated liver disease, sepsis and admission to intensive care unit were independent risk factors for fatal outcome. Lethal sepsis in patients positive for non-fermenting bacteria was significantly more frequent than in those positive for Enterobacteriaceae, independently from liver function. Subgroup analysis of cirrhotic patients showed that sepsis (54.9% vs. 13%) and lethal sepsis were significantly more frequent after detection of carbapenem-resistant gram-negative bacteria, independently from localization of pathogen detection. Conclusions Patients with advanced liver disease are prone to fatal infections caused by carbapenem-resistant gram-negative bacteria. This article is protected by copyright. All rights reserved.