| Aims:The aim is to describe the epidemiological characteristics of bacterial infections caused by multidrug resistance(MDR)bacteria in patients with cirrhosis,the risk factors for infection and the impact on mortality.Methods:A retrospective study was performed on patients with cirrhosis of bacterial infection who were positive for hospitalization in the First Affiliated Hospital of Zhejiang University School of Medicine from January 2011 to January 2017.Their demographic data,clinical and microbiological data,and 28-day follow-up data after positive cultures were excluded,excluding patients with incomplete clinical data,age<18 years,immunodeficiency,transplantation,and fungal infections.A total of 563 patients were enrolled in the study to analyze the epidemiological characteristics,risk factors,and mortality effects of MDR bacterial infections in these patients.Statistical methods were continuous variables expressed as mean±standard deviation(SD)or median and interquartile range(IQR)and compared using Student's t test or Mann-Whitney U test.The nominal variables are expressed in numbers and frequencies and compared using a chi-square test.To avoid artificially expanding the sample size,patients with more than one infection event were counted as one patient for mortality calculations.The Cox proportional hazard model was used to assess the risk of variables associated with 28-day mortality.Survival curves were compared using a log-rank test.Results:A total of 635 infections were included in 563 patients with cirrhosis.Bacterial infections caused by multidrug resistance(MDR)isolates accounted for 44.1%(280/635)of the total seizures,more than half of which were obtained from hospitals(53.2%).After comparing demographic and clinical data from patients with MDR and non-MDR,two factors associated with MDR bacterial infection were:(1)more frequent use of antibiotics prior to admission(46.8%vs 32%,p<0.001(2)Gastrointestinal bleeding episodes at admission(19.4%vs 10.1%,p=0.002)and bacterial infections(52.8%vs 40.9%,p=0.005).Analysis of microbiological data revealed that Gram-negative bacteria were more common in MDR isolates than Gram-positive bacteria(66.4%vs 33.6%).Among the common MDR origins,CRE is the most frequently isolated pathogen(n=91),followed by VSE/VRE and ESBL Enterobacteriaceae(n=54 and n=50,respectively).The most common site of MDR isolation at the site of infection was the respiratory tract(36.4%,episode 102),followed by the abdominal cavity(35.4%,episode 99).The initial failure rate of antibiotic therapy in patients infected with MDR bacteria was higher than in non-MDR group(32.9%vs 25.7%,p<0.001),and vasoconstrictor drug use rate was higher(18.2%vs 9.3%,p<0.001),28 days of death.The rate was also significantly higher than in patients with non-MDR infection(25.1%vs 17.4%,p=0.025).However,this increase in mortality was not associated with gender,age,and severity of cirrhosis,primarily due to methicillin-resistant Staphylococcus aureus(MRSA)infection.After adjusting for age,gender,and end-stage liver disease(MELD)scoring models,MRSA infection alone was an independent risk factor for 28-day mortality in the multivariate Cox proportional hazards regression model(HR 2.964,95%CI(1.175-7.478),p=0.021).Conclusions:MDR bacterial infection is common in patients with cirrhosis,and Gram-negative bacteria are the main infections,especially CRE infections occur more frequently.Infection with MDR is associated with recent antibiotic use and reduces the response rate to initial antibiotic therapy at admission and increases the use of vasoconstrictive drugs.Infection with MRSA significantly increases short-term mortality. |
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