Bloodstream infection in cirrhotic patients: a prospective multicenter study (bichrome)

Michele Bartoletti

Several aspects of bloodstream infections (BSI) in patients with liver cirrhosis (LC) need to be clarified. In this prospective, multicentre, observational study, conducted form Sep-2014 to Dec-2015 in 16 teaching-hospitals among 5 different countries we enrolled all adult patients with LC developing BSI. The aims of the study were to: (1) clarify the epidemiology and outcome of BSI in LC and (2) to identify risk factors for multidrug-resistant pathogens. Data were collected in an electronic case report form at the study web site and patients were followed-up for 30 days after BSI diagnosis. Overall, a total of 312 patients with a BSI episode were included for a total of 337 isolates identified. Gram-negative bacteria (GNB) accounted for 164/312 BSIs (53%), whereas gram-positive bacteria were found in 146/312 (47%) of episodes. A significant variability of etiology was found among different countries and among patients with different cause of LC. CLIF-SOFA showed the best performance in the identification of patients at risk of 30-day mortality (AUROC 0.733; R2 0.93). Risk factors for multidrug resistant pathogens isolation were previous (<30 days) antibiotic exposure [HR 3.73 (95% CI 2.09-6.66), p<0.001] and previous gastrointestinal bleeding (<30 days) [HR 4.25 (95% CI 1.84-9.84), p=0.001].

Simone Agnello
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