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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
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The multi-drug resistant organisms infections decrease during the antimicrobial stewardship era in cirrhotic
Andrea Dalbeni1,2, Anna Mantovani1,2, Mirko Zoncapè1,2
1Division of General Medicine C, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Plos One
|February 16, 2023
Summary
Bacterial infections are common in cirrhosis patients. An antimicrobial stewardship program (SAVE) reduced multidrug-resistant organism infections, though overall infections increased, highlighting the need for surveillance.
Area of Science:
- Medical Microbiology
- Hepatology
- Infectious Diseases
Background:
- Bacterial infections significantly increase morbidity and mortality in patients with cirrhosis.
- Multidrug-resistant organisms (MDROs) pose a particular challenge in this vulnerable population.
Purpose of the Study:
- To evaluate the incidence of bacterial infections, including those caused by MDROs, in cirrhotic patients.
- To assess the impact of the "Stewardship Antimicrobial in VErona" (SAVE) program on MDRO infections.
- To analyze liver complications and mortality associated with bacterial infections.
Main Methods:
- A cohort of 229 cirrhotic patients without prior infection-related hospitalization was studied.
- Data were collected from 2017 to 2019, with follow-up until December 2021.
- Incidence rates of infections, MDROs, liver complications, and mortality were analyzed.
Main Results:
- 101 infections were recorded; sepsis, pneumonia, and spontaneous bacterial peritonitis were most common.
- 14.9% of infections were caused by MDROs. MDRO infections correlated with higher MELD and Child-Pugh scores.
- The SAVE program introduction coincided with a decrease in MDRO infection incidence (IRD 28.6; p = 0.02).
Conclusions:
- Bacterial infections, especially MDROs, are a significant burden in cirrhosis and are linked to liver complications.
- The SAVE program effectively reduced MDRO infections in this patient group.
- Enhanced clinical surveillance is crucial to identify colonized patients and prevent MDRO spread in cirrhotic patients.
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