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Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2016/05  
 
  2016 May;63(5):1632-9.  
  doi: 10.1002/hep.28332  
 
  An empirical broad spectrum antibiotic therapy in health-care-associated infections improves survival in patients with cirrhosis: A randomized trial.  
 
  Merli M, Lucidi C, Di Gregorio V, Lattanzi B, Giannelli V, Giusto M, Farcomeni A, Ceccarelli G, Falcone M, Riggio O, Venditti M  
  http://www.ncbi.nlm.nih.gov/pubmed/26529126  
 
 

Early diagnosis and appropriate treatment of infections in cirrhosis are crucial because of their high morbidity and mortality. Multidrug-resistant (MDR) infections are on the increase in health care settings. Health-care-associated (HCA) infections are still frequently treated as community-acquired with a detrimental effect on survival. We aimed to prospectively evaluate in a randomized trial the effectiveness of a broad spectrum antibiotic treatment in patients with cirrhosis with HCA infections. Consecutive patients with cirrhosis hospitalized with HCA infections were enrolled. After culture sampling, patients were promptly randomized to receive a standard or a broad spectrum antibiotic treatment (NCT01820026). The primary endpoint was in-hospital mortality. Efficacy, side effects, and the length of hospitalization were considered. Treatment failure was followed by a change in antibiotic therapy. Ninety-six patients were randomized and 94 were included. The two groups were similar for demographic, clinical, and microbiological characteristics. The prevalence of MDR pathogens was 40% in the standard versus 46% in the broad spectrum group. In-hospital mortality showed a substantial reduction in the broad spectrum versus standard group (6% vs. 25%; P = 0.01). In a post-hoc analysis, reduction of mortality was more evident in patients with sepsis. The broad spectrum showed a lower rate of treatment failure than the standard therapy (18% vs. 51%; P = 0.001). Length of hospitalization was shorter in the broad spectrum (12.3 ± 7 days) versus standard group (18 ± 15 days; P = 0.03). Five patients in each group developed a second infection during hospitalization with a similar prevalence of MDR (50% broad spectrum vs. 60% standard).

CONCLUSIONS:

A broad spectrum antibiotic therapy as empirical treatment in HCA infections improves survival in cirrhosis. This treatment was significantly effective, safe, and cost saving. (Hepatology 2016;63:1632-1639).

 
Question posée
 
Quelle antibiothérapie empirique faut-il prescrire chez les patients cirrhotiques ayant une infection à l’hospitalisation ou dans les 48heures en rapport avec hospitalisation ou prise en charge dans une institution antérieure (Health-care-associated (HCA)) ?
 
Question posée
 
La mortalité hospitalière est réduite significativement chez les patients traités par une antibiothérapie à large spectre (basée sur Imipénème/cilastine) vs l’antibiothérapie standard (cefotaxime) : 6% vs. 25%; P = 0,01 avec une diminution de la durée d’hospitalisation
 
Commentaires

Etude italienne à confirmer en France en raison d’une écologie bactérienne différente mais…tentant d’utiliser ce type d’antibiothérapie chez les cirrhotiques sévères.

 
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