Bacterial infections are common in patients with decompensated liver cirrhosis and a leading cause of death. Reliable data on antibiotic resistance are required to initiate effective empiric therapy. We here aim to assess the antimicrobial resistance profile of bacteria among patients with liver cirrhosis and infection. Overall, 666 cirrhotic patients admitted to Hannover Medical School between January 2012 and April 2018 with ascites were assessed for bacterial infection. In case of infection, bacteria cultured from microbiological specimens of ascites, blood or urine were identified and analyzed for resistances against common antibiotic agents. Furthermore, analyses compared two periods of time and community-acquired vs. nosocomial infections. In 281 patients with infection, microbiological sampling was performed and culture-positive results were obtained in 56.9%. Multidrug-resistant (MDR)-bacteria were found in 54 patients (19.2%). Gram-positive organisms were more common (n = 141/261, 54.0%) and detected in 116/192 culture-positive infections (60.4%). Comparing infections before and after 2015, a numerical decline for MDR-bacteria (23.8% vs. 15.6%, p = 0.08) was observed with a significant decline in meropenem resistance (34.9% vs. 19.5%, p = 0.03). MDR-bacteria were more frequent in the case of nosocomial infections. Of note, in ascites the majority of the tested bacteria were resistant against ceftriaxone (73.8%) whereas significantly less were resistant against meropenem (27.0%) and vancomycin (25.9%). In our tertiary center, distinct ratios of gram-positive infection with overall low ratios of MDR-bacteria were found. Adequate gram-positive coverage in the empiric therapy should be considered. Carbapenem treatment may be omitted even in nosocomial infection. In contrast, 3rd generation cephalosporins cannot be recommended even in community-acquired infection in our cirrhotic population.

中文翻译：

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德国北部一家三级中心失代偿性肝硬化合并细菌感染患者的抗生素耐药性

细菌感染在失代偿性肝硬化患者中很常见，是导致死亡的主要原因。需要有关抗生素耐药性的可靠数据来启动有效的经验性治疗。我们在此旨在评估肝硬化和感染患者中细菌的抗菌素耐药性。总体而言，对 2012 年 1 月至 2018 年 4 月间因腹水入院汉诺威医学院的 666 名肝硬化患者进行了细菌感染评估。在感染的情况下，从腹水、血液或尿液的微生物标本中培养的细菌被鉴定并分析对常见抗生素药物的耐药性。此外，分析比较了两个时间段和社区获得性感染与医院感染。在 281 名感染患者中，进行了微生物取样，56.9% 的人获得了培养阳性结果。在 54 名患者（19.2%）中发现了耐多药 (MDR) 细菌。革兰氏阳性菌更常见（n = 141/261, 54.0%），并在 116/192 培养阳性感染（60.4%）中检测到。比较 2015 年之前和之后的感染，观察到耐多药细菌的数量下降（23.8% 对 15.6%，p = 0.08），而美罗培南耐药性显着下降（34.9% 对 19.5%，p = 0.03）。在医院感染的情况下，耐多药细菌更常见。值得注意的是，在腹水中，大多数受试细菌对头孢曲松 (73.8%) 有耐药性，而对美罗培南 (27.0%) 和万古霉素 (25.9%) 的耐药性明显较低。在我们的第三中心，发现了明显比例的革兰氏阳性菌感染与总体低 MDR 细菌比例。应考虑在经验性治疗中充分覆盖革兰氏阳性菌。即使在医院感染中也可以省略碳青霉烯类治疗。相比之下，即使在我们肝硬化人群的社区获得性感染中，也不推荐使用第三代头孢菌素。