Impact of multidrug resistance on the management of bacterial infections in cirrhosis  

作　　者：Carlos Terra Ângelo Zambam de Mattos Marcelo Souza Chagas Andre Torres Denusa Wiltgen Barbara Muniz Souza Renata Mello Perez 

机构地区：[1]Gastroenterology-Liver Unit,State University of Rio de Janeiro,Rio de Janeiro 20551-030,Rio de Janeiro,Brazil [2]Liver Unit,Casa de Saúde São José-Rede Santa Catarina,Rio de Janeiro 22271-080,Rio de Janeiro,Brazil [3]Alliance of Brazilian Centers for Cirrhosis Car,The ABC Group,Rio de Janeiro 20551-030,Rio de Janeiro,Brazil [4]Liver Unit,Federal Hospital of Lagoa,Rio de Janeiro 22470-050,Rio de Janeiro,Brazil [5]Graduate Program in Medicine:Hepatology,Federal University of Health Sciences of Porto Alegre,Porto Alegre 90020-090,Rio Grande do Sul,Brazil [6]Gastroenterology and Hepatology Unit,Irmandade Santa Casa de Misericórdia de Porto Alegre,Porto Alegre 90020-090,Rio Grande do Sul,Brazil [7]Internal Medicine,Federal Hospital of Lagoa,Rio de Janeiro 22470-050,Rio de Janeiro,Brazil [8]Department of Internal Medicine,Federal University of Health Sciences of Porto Alegre,Porto Alegre 90020-090,Brazil [9]Hepatology Division,Federal University of Rio de Janeiro,Rio de Janeiro 21941-617,Rio de Janeiro,Brazil [10]IDOR,D’Or Institute for Research and Education,Rio de Janeiro 22281-100,Rio de Janeiro,Brazil

出　　处：《World Journal of Clinical Cases》2023年第3期534-544,共11页世界临床病例杂志

摘　　要：Patients with cirrhosis have an increased risk of infection and differently from other complications,that over the years are improving in their outcomes,infections in cirrhotic patients are still a major cause of hospitalization and death(up to 50%in-hospital mortality).Infections by multidrug-resistant organisms(MDRO)have become a major challenge in the management of cirrhotic patients with significant prognostic and cost-related impact.About one third of cirrhotic patients with bacterial infections is infected with MDR bacteria and their prevalence has increased in recent years.MDR infections have a worse prognosis compared to infections by non-resistant bacteria because they are associated with lower rate of infection resolution.An adequate management of cirrhotic patients with infections caused by MDR bacteria depends on the knowledge of some epidemiological aspects,such as the type of infection(spontaneous bacterial peritonitis,pneumonia,urinary tract infection and spontaneous bacteremia),bacteriological profile of antibiotic resistance at each health care unit and site of infection acquisition(community acquired,healthcare associated or nosocomial).Furthermore,regional variations in the prevalence of MDR infections determine that the choice of empirical antibiotic therapy must be adapted to the local microbiological epidemiology.Antibiotic treatment is the most effective measure to treat infections caused by MDRO.Therefore,optimizing antibiotic prescribing is critical to effectively treat these infections.Identification of risk factors for multidrug resistance is essential to define the best antibiotic treatment strategy in each case and the choice of an effective empirical antibiotic therapy and its early administration is cardinal to reduce mortality.On the other hand,the supply of new agents to treat these infections is very limited.Thus,specific protocols that include preventive measures must be implemented in order to limit the negative impact of this severe complication in cirrhotic patients.

关 键 词：CIRRHOSIS Infection MULTIDRUG-RESISTANCE BACTERIAL ANTIBIOTICS MICROBIOTA 

分 类 号：R575.2[医药卫生—消化系统]