Towards evidence-based empiric antibiotic recommendations for spontaneous infections in patients with cirrhosis

IF 4 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive and Liver Disease Pub Date : 2025-02-01 DOI:10.1016/j.dld.2024.07.023
Melisa Dirchwolf , Gonzalo Gomez Perdiguero , Fernando Cairo , Carolina Vazquez , Lorena Notari , Maria Dolores Murga , Martin Elizondo , Fernando Bessone , Marina Agozino , Julia Brutti , Alina Raquel Zerega , Josefina Pages , Teodoro Eduardo Stieben , Pablo Calzetta , Diego Arufe , Esteban González Ballerga , Diego Giunta , Astrid Smud , Brenda Osso Sanchez , Lucia Navarro , Sebastián Marciano
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Abstract

Background

With the emergence of multidrug-resistant infections, healthcare professionals must evaluate the effectiveness of empiric antibiotic treatments.

Aims

To assess the antibiotic susceptibility patterns of microorganisms causing spontaneous infections in patients with cirrhosis and to evaluate the suitability of empiric antibiotic treatments based on major clinical guidelines.

Methods

This cross-sectional study utilized two datasets from prospective studies of patients with cirrhosis and culture-positive spontaneous bacterial infections in Argentina and Uruguay. We estimated susceptibility to commonly used antibiotics and assessed coverage following European and American recommendations.

Results

We analyzed 238 episodes of culture-positive spontaneous infections in 229 patients. When implementing the recommendations for empiric treatment of community-acquired spontaneous infections, ceftazidime would result in 39 % coverage, whereas ceftriaxone would reach 70 %. Cefepime, which is not included in the recommendations, would have provided coverage of 74 %. Using ertapenem for nosocomial infections would have only covered 56 % of these episodes, whereas meropenem or imipenem reached 73 % coverage. Only the combination of meropenem or imipenem plus vancomycin would achieve a coverage surpassing 85 % in healthcare-associated or nosocomial spontaneous bacterial infections.

Conclusions

Our study uncovers inadequate coverage in specific clinical scenarios when adhering to recommendations, underscoring the necessity of guidelines based on local epidemiological data.
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针对肝硬化患者自发感染的循证经验性抗生素建议。
背景:随着耐多药感染的出现,医护人员必须评估经验性抗生素治疗的有效性:目的:评估引起肝硬化患者自发感染的微生物的抗生素敏感性模式,并根据主要临床指南评估经验性抗生素治疗的适宜性:这项横断面研究利用了阿根廷和乌拉圭肝硬化患者和培养阳性自发性细菌感染前瞻性研究的两个数据集。我们估算了常用抗生素的敏感性,并评估了欧美建议的覆盖范围:我们分析了 229 名患者的 238 例培养阳性自发感染病例。根据社区获得性自发感染经验性治疗的建议,头孢他啶的覆盖率为 39%,而头孢曲松的覆盖率为 70%。建议中未包括头孢吡肟,但其覆盖率可达 74%。对医院内感染使用厄他培南只能覆盖 56% 的病例,而美罗培南或亚胺培南的覆盖率则达到 73%。只有美罗培南或亚胺培南加万古霉素的组合才能在与医疗保健相关的自发细菌感染或病原菌感染中达到 85% 以上的覆盖率:我们的研究发现,在特定的临床情况下,按照建议用药的覆盖率并不充分,这强调了根据当地流行病学数据制定指导方针的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Digestive and Liver Disease
Digestive and Liver Disease 医学-胃肠肝病学
CiteScore
6.10
自引率
2.20%
发文量
632
审稿时长
19 days
期刊介绍: Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.
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