Rectal colonization by resistant bacteria increases the risk of infection by the colonizing strain in critically ill patients with cirrhosis,Journal of Hepatology

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Rectal colonization by resistant bacteria increases the risk of infection by the colonizing strain in critically ill patients with cirrhosis
Journal of Hepatology ( IF 26.8 ) Pub Date : 2022-01-22 , DOI: 10.1016/j.jhep.2021.12.042
Verónica Prado ₁ , María Hernández-Tejero ₂ , Marcus M Mücke ₃ , Francesc Marco ₄ , Wenyi Gu ₃ , Alex Amoros ₅ , David Toapanta ₂ , Enric Reverter ₂ , Carlos de la Peña-Ramirez ₅ , Laura Altenpeter ₃ , Octavi Bassegoda ₂ , Gabriel Mezzano ₂ , Fátima Aziz ₂ , Adria Juanola ₂ , Sergio Rodríguez-Tajes ₂ , Vanessa Chamorro ₂ , David López ₂ , Marta Reyes ₂ , Michael Hogardt ₆ , Volkhard A J Kempf ₆ , Philip G Ferstl ₃ , Stefan Zeuzem ₃ , José Antonio Martínez ₇ , Jordi Vila ₄ , Vicente Arroyo ₅ , Jonel Trebicka ₈ , Javier Fernandez ₉

Affiliation

Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS and CIBERehd, Spain; Hepato-Gastro-enterology Department, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS and CIBERehd, Spain.
Department for Internal Medicine I, Goethe University Frankfurt, Germany.
Microbiology Department, Hospital Clinic, University of Barcelona, Spain; ISGlobal, Hospital Clínic - University of Barcelona, Spain.
EF Clif, EASL-CLIF Consortium, Barcelona, Spain.
Institute of Medical Microbiology and Infection Control, Goethe University Frankfurt, Germany; University Center for Infectious Diseases, University Hospital Frankfurt, Germany; University Center of Competence for Infection Control, State of Hesse, Germany.
Infectious Disease Department, Hospital Clinic, Barcelona, Spain.
Department for Internal Medicine I, Goethe University Frankfurt, Germany; EF Clif, EASL-CLIF Consortium, Barcelona, Spain.
Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS and CIBERehd, Spain; EF Clif, EASL-CLIF Consortium, Barcelona, Spain.

Background & Aims

It remains unclear whether rectal colonization with multidrug-resistant organisms (MDROs) is prevalent and predisposes to infections by the same pathogens in patients with cirrhosis.

Methods

Two series of critically ill patients were evaluated. In the Barcelona cohort, 486 consecutive patients were prospectively evaluated, 129 with and 357 without cirrhosis (2015-2016). Rectal swabs were performed at admission and weekly thereafter (until intensive care unit [ICU] discharge) to detect MDRO colonization. Risk factors for colonization and infection by MDROs were evaluated. A retrospective cohort from Frankfurt (421 patients with cirrhosis; 2010-2018) was investigated to evaluate MDRO rectal colonization in another epidemiological scenario.

Results

In the Barcelona cohort, 159 patients were colonized by MDROs (32.7%), 102 (64.2%) at admission and 57 (35.8%) during follow-up. Patients with cirrhosis showed higher rates of rectal colonization at admission than those without cirrhosis (28.7% vs. 18.2%, p = 0.01) but similar colonization rates during ICU stay. Extended-spectrum beta-lactamase-Enterobacterales were the most frequent MDROs isolated in both groups. Colonization by MDROs independently increased the risk of infection by MDROs at admission and during follow-up. Risk of new infection by the colonizing strain was also significantly increased in patients with (hazard ratio [HR] 7.41) and without (HR 5.65) cirrhosis. Rectal colonization by MDROs was also highly prevalent in Frankfurt (n = 198; 47%; 131 at admission [66.2%] and 67 [33.8%] during follow-up), with vancomycin-resistant enterococci being the most frequent colonizing organism. Rectal colonization by MDROs was also associated with an increased risk of infection by MDROs in this cohort. Infections occurring in MDR carriers were mainly caused by the colonizing strain.

Conclusion

Rectal colonization by MDROs is extremely frequent in critically ill patients with cirrhosis. Colonization increases the risk of infection by the colonizing resistant strain.

Lay summary

Rectal colonization by multidrug-resistant organisms (MDROs) is a prevalent problem in patients with cirrhosis requiring critical care. The pattern of colonizing bacteria is heterogeneous with relevant differences between centers. Colonization by MDROs is associated with increased risk of infection by the colonizing bacteria in the short term. This finding suggests that colonization data could be used to guide empirical antibiotic therapy and de-escalation policies in patients with cirrhosis.

中文翻译：

耐药菌的直肠定植增加了重症肝硬化患者的定植菌株感染风险

背景与目标

目前尚不清楚多药耐药菌 (MDRO) 的直肠定植是否普遍存在，并且是否会导致肝硬化患者受到相同病原体的感染。

方法

评估了两个系列的重症患者。在巴塞罗那队列中，对 486 名连续患者进行了前瞻性评估，其中 129 名患有肝硬化，357 名没有肝硬化（2015-2016 年）。入院时和之后每周（直到重症监护室 [ICU] 出院）进行直肠拭子检测以检测 MDRO 定植。评估了 MDRO 定植和感染的危险因素。一项来自法兰克福的回顾性队列（421 名肝硬化患者；2010-2018 年）进行了调查，以评估另一种流行病学情况下的 MDRO 直肠定植。

结果

在巴塞罗那队列中，159 名患者（32.7%）、102 名（64.2%）入院时和 57 名（35.8%）在随访期间被 MDRO 定植。肝硬化患者入院时直肠定植率高于非肝硬化患者（28.7% vs. 18.2%，p = 0.01)，但在 ICU 期间的定植率相似。超广谱β-内酰胺酶-肠杆菌是两组中最常见的MDRO。MDRO 的定植独立地增加了入院和随访期间 MDRO 感染的风险。在肝硬化患者（风险比 [HR] 7.41）和非肝硬化患者（HR 5.65）中，定植菌株新感染的风险也显着增加。MDRO 的直肠定植在法兰克福也非常普遍（n = 198；47%；入院时 131 人 [66.2%] 和随访期间 67 人 [33.8%]），其中耐万古霉素肠球菌是最常见的定植微生物。MDRO 的直肠定植也与该队列中 MDRO 感染的风险增加有关。MDR 携带者中发生的感染主要是由定植菌株引起的。