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Intestinal colonization with resistant bacteria: a prognostic marker of mortality in decompensated cirrhosis
S Pouriki1, G Vrioni2, H Sambatakou1
12nd Department of Internal Medicine and Research Laboratory, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vas Sophias St, Athens, Greece.
Abstract:
Infections due to drug-resistant (DR) bacteria are increasingly recognized as an emerging problem worldwide. Asymptomatically colonized patients may contribute to the reservoir in the hospital setting, causing both horizontal transmission and endogenous infections. We aimed to evaluate the prevalence of intestinal colonization with DR bacteria on subsequent clinical infection development and prognosis in patients with decompensated cirrhosis. One hundred seven patients without infection at baseline were screened and prospectively followed-up for 3 months. Among the patients screened, DR bacteria were isolated in 47 (43.9%), 14 colonized with multidrug- (MDR) and 33 with extensively drug (XDR)-resistant bacteria or a mixture of MDR/XDR bacteria. Severity of liver disease and demographic characteristics were similar among groups. The 20 (42.6%) with DR vs 14 (23.3%) without had hepatic encephalopathy and/or spontaneous bacterial peritonitis episodes over the past 6 months (p = 0.034). One third of both DR and non-DR groups developed infection during follow-up but in only 7 and 5, respectively, the infection was microbiologically documented. In a 3-month-follow-up period, mortality was higher in patients colonized with XDR compared to those without (log rank p = 0.027). In multivariate analysis, colonization with XDR bacteria [HR = 1.074, (CI:1.024-1.126), p = 0.003] and MELD score [HR = 2.579 (1.109-5.996), p = 0.028] were independently associated with low survival. Asymptomatic GI colonization with DR bacteria is a risk factor for increased mortality in decompensated cirrhosis. Frequent hospitalizations for complications of the underlying disease and selective pressure induced by the use of antimicrobials are probably the main determinants.
Insights
Asymptomatic intestinal colonization with drug-resistant bacteria significantly increases mortality risk in decompensated cirrhosis patients. This highlights the need for targeted interventions in this vulnerable population.
Area of Science:
- Infectious Diseases
- Hepatology
- Microbiology
Background:
- Drug-resistant (DR) bacterial infections pose a growing global health threat.
- Asymptomatic colonization in hospitals can lead to transmission and endogenous infections.
- Patients with decompensated cirrhosis are a vulnerable population susceptible to infections.
Purpose of the Study:
- To determine the prevalence of intestinal colonization with DR bacteria in patients with decompensated cirrhosis.
- To assess the association between DR bacterial colonization and subsequent clinical infection.
- To evaluate the impact of DR bacterial colonization on prognosis and survival in these patients.
Main Methods:
- Prospective follow-up of 107 patients with decompensated cirrhosis for 3 months.
- Screening for intestinal colonization with multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacteria.
- Analysis of clinical outcomes, including infection development and mortality, in relation to colonization status.
Main Results:
- 43.9% of patients were colonized with DR bacteria (MDR/XDR).
- DR colonization was associated with a history of hepatic encephalopathy or spontaneous bacterial peritonitis.
- Mortality was significantly higher in patients colonized with XDR bacteria (log rank p=0.027).
- XDR colonization and MELD score were independent predictors of reduced survival (p=0.003 and p=0.028, respectively).
Conclusions:
- Asymptomatic gastrointestinal colonization with DR bacteria is a significant risk factor for increased mortality in decompensated cirrhosis.
- Frequent hospitalizations and antimicrobial use likely contribute to DR bacterial colonization in this group.
- Findings underscore the importance of monitoring and managing DR bacteria in hospitalized patients with liver disease.
