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Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Gastroenterology
  2019/04  
 
  2019 Apr;156(5):1368-1380.e10.  
  doi: 10.1053/j.gastro.2018.12.005.  
 
  Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide.  
 
  Piano S, Singh V, Caraceni P, Maiwall R, Alessandria C, Fernandez J, Soares EC, Kim DJ, Kim SE, Marino M, Vorobioff J, Barea RCR, Merli M, Elkrief L, Vargas V, Krag A, Singh SP, Lesmana LA, Toledo C, Marciano S, Verhelst X, Wong F, Intagliata N, Rabinowich L, Colombato L, Kim SG, Gerbes A, Durand F, Roblero JP, Bhamidimarri KR, Boyer TD, Maevskaya M, Fassio E, Kim HS, Hwang JS, Gines P, Gadano A, Sarin SK, Angeli P; International Club of Ascites Global Study Group.  
  https://www.ncbi.nlm.nih.gov/pubmed/30552895  
 
 

Abstract

BACKGROUND & AIMS:

Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis.

METHODS:

We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge.

RESULTS:

The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%-37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival.

CONCLUSIONS:

In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.

 

 
Question posée
 
Evaluer la prévalence et le devenir des infections bactériennes et fungiques chez les patients cirrhotiques.
 
Question posée
 
La prévalence globale des bactéries “multidrug-resistantes” (MDR) est de 34%, variant d’une partie à l’autre du monde avec la plus grande prévalence en Asie. Les infections avec des bactéries MDR sont associées à un plus faible taux de guérison, à une augmentation du risque de choc et de défaillance d’organe et enfin à une mortalité hospitalière plus élevée.
 
Commentaires

Tous les facteurs sont bien connus, à nous d’être le plus vigilants possibles en fonction de l’écologie bactérienne propre à chaque hôpital.

 
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