1. Clinical and microbiological features of infection in alcoholic hepatitis: an international cohort study
- Author
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Ashish Sinha, Richard D. Parker, Gene Im, Stephen Stewart, Onan Pérez Hernández, Guruprasad P. Aithal, M. J. Sánchez-Pérez, Fiona Jones, Andrew Holt, Emilio González-Reimers, Chris Corbett, Anne McCune, Miruna D. David, Jonathan Nahas, Antonella Ghezzi, Daniel Wheatley, and Aditi Kumar
- Subjects
0301 basic medicine ,Male ,medicine.medical_specialty ,medicine.drug_class ,Antibiotics ,Alcoholic hepatitis ,Kaplan-Meier Estimate ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Adrenal Cortex Hormones ,Risk Factors ,Internal medicine ,Drug Resistance, Bacterial ,medicine ,Humans ,Antibiotic prophylaxis ,Risk factor ,Proportional Hazards Models ,Retrospective Studies ,Original Article—Liver, Pancreas, and Biliary Tract ,Bacteria ,business.industry ,Hepatitis, Alcoholic ,Incidence ,Hazard ratio ,Gastroenterology ,Retrospective cohort study ,Bacterial Infections ,Antibiotic Prophylaxis ,Middle Aged ,medicine.disease ,Virology ,United States ,3. Good health ,Anti-Bacterial Agents ,Europe ,030104 developmental biology ,Mycoses ,Cohort ,030211 gastroenterology & hepatology ,Female ,Liver diseases, alcoholic ,business ,Infection ,Cohort study - Abstract
Background Previous studies have described the clinical impact of infection in alcoholic hepatitis (AH) but none have comprehensively explored the aetiopathogenesis of infection in this setting. We examined the causes, consequences and treatment of infection in a cohort of patients with AH. Methods We undertook a retrospective cohort study of patients with AH admitted between 2009 and 2014 to seven centres in Europe and the USA. Clinical and microbiological data were extracted from medical records. Survival was analysed with Kaplan–Meier analysis and Cox proportional hazards analysis to control the data for competing factors. Propensity score matching was used to examine the efficacy of prophylactic antibiotics administered in the absence of infection. Results We identified 404 patients with AH. Of these, 199 (49%) showed clinical or culture evidence of infection. Gut commensal bacteria, particularly Escherichia coli and Enterobacter species, were most commonly isolated in culture. Fungal infection was rarely seen. Cultured organisms and antibiotic resistance differed markedly between centres. Infection was an independent risk factor for death (hazard ratio for death at 90 days 2.33, 95% confidence interval 1.63–3.35, p
- Published
- 2017