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1. Clinical Management of Adult Patients with COVID-19 Outside Intensive Care Units: Guidelines from the Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP)

Author

Pierachille Santus, Stefano Centanni, Emanuela Sozio, Carlo Vancheri, Elena Tagliabue, Carlo Tascini, Daniele Roberto Giacobbe, Federico Pea, Guido Granata, Francesco Blasi, Pierluigi Viale, Angelo Gratarola, Nicola Petrosillo, Alessio Signori, Dejan Radovanovic, Nadia Castaldo, Andrea Lombardi, Alberto Enrico Maraolo, Malgorzata Mikulska, Andrea Gori, Andrea Gramegna, Fabiano Di Marco, Francesco Giuseppe De Rosa, Antonio Vena, Silvia Corcione, Paolo Bruzzi, Emanuela Barisione, Matteo Bassetti, Bassetti M., Giacobbe D.R., Bruzzi P., Barisione E., Centanni S., Castaldo N., Corcione S., De Rosa F.G., Di Marco F., Gori A., Gramegna A., Granata G., Gratarola A., Maraolo A.E., Mikulska M., Lombardi A., Pea F., Petrosillo N., Radovanovic D., Santus P., Signori A., Sozio E., Tagliabue E., Tascini C., Vancheri C., Vena A., Viale P., and Blasi F.

Subjects
Microbiology (medical), medicine.medical_specialty, Best practice, medicine.medical_treatment, Guideline, Guidelines, law.invention, chemistry.chemical_compound, Tocilizumab, Randomized controlled trial, law, Intensive care, Internal medicine, medicine, Continuous positive airway pressure, Intensive care medicine, Grading (education), business.industry, COVID-19, SARS-CoV-2, Infectious Diseases, Systematic review, Pulmonology, chemistry, business
Abstract

Introduction The Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP) constituted an expert panel for developing evidence-based guidance for the clinical management of adult patients with coronavirus disease 2019 (COVID-19) outside intensive care units. Methods Ten systematic literature searches were performed to answer ten different key questions. The retrieved evidence was graded according to the Grading of Recommendations Assessment, Development, and Evaluation methodology (GRADE). Results and Conclusion The literature searches mostly assessed the available evidence on the management of COVID-19 patients in terms of antiviral, anticoagulant, anti-inflammatory, immunomodulatory, and continuous positive airway pressure (CPAP)/non-invasive ventilation (NIV) treatment. Most evidence was deemed as of low certainty, and in some cases, recommendations could not be developed according to the GRADE system (best practice recommendations were provided in similar situations). The use of neutralizing monoclonal antibodies may be considered for outpatients at risk of disease progression. For inpatients, favorable recommendations were provided for anticoagulant prophylaxis and systemic steroids administration, although with low certainty of evidence. Favorable recommendations, with very low/low certainty of evidence, were also provided for, in specific situations, remdesivir, alone or in combination with baricitinib, and tocilizumab. The presence of many best practice recommendations testified to the need for further investigations by means of randomized controlled trials, whenever possible, with some possible future research directions stemming from the results of the ten systematic reviews. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00487-7.

Published
2021

2. Prospective Study on Incidence, Risk Factors and Outcome of Recurrent

Author

Erica Franceschini, Malgorzata Mikulska, Andrea Lombardi, Gregorio Basile, Laura Isabella Lupo, Giambattista Lobreglio, Daniele Roberto Giacobbe, Giancarlo Ceccarelli, Maria Adriana Cataldo, Anna Maria De Luca, Mario Venditti, Stefano Di Bella, Emanuela Caraffa, Michele Bartoletti, Enrica Giacometti, Nicola Petrosillo, Matteo Bassetti, Alessandra Oliva, Guido Granata, Ivan Gentile, Pierluigi Viale, Cristina Mussini, Alessandro Pandolfo, Paolo Bonfanti, Raffaella Borromeo, Sara Fossati, Alessandra Mularoni, Lucia Adamoli, Fabrizio Ingrassia, Filippo Lagi, Alberto Enrico Maraolo, Carlotta Rogati, Filippo Trapani, Roberto Luzzati, Alessandro Bartoloni, Mario U. Mondelli, Granata, G, Petrosillo, N, Adamoli, L, Bartoletti, M, Bartoloni, A, Basile, G, Bassetti, M, Bonfanti, P, Borromeo, R, Ceccarelli, G, De Luca, A, Di Bella, S, Fossati, S, Franceschini, E, Gentile, I, Giacobbe, D, Giacometti, E, Ingrassia, F, Lagi, F, Lobreglio, G, Lombardi, A, Lupo, L, Luzzati, R, Maraolo, A, Mikulska, M, Mondelli, M, Mularoni, A, Mussini, C, Oliva, A, Pandolfo, A, Rogati, C, Trapani, F, Venditti, M, Viale, P, Caraffa, E, Cataldo, M, Granata, Guido, Petrosillo, Nicola, Adamoli, Lucia, Bartoletti, Michele, Bartoloni, Alessandro, Basile, Gregorio, Bassetti, Matteo, Bonfanti, Paolo, Borromeo, Raffaella, Ceccarelli, Giancarlo, De Luca, Anna Maria, Di Bella, Stefano, Fossati, Sara, Franceschini, Erica, Gentile, Ivan, Giacobbe, Daniele Roberto, Giacometti, Enrica, Ingrassia, Fabrizio, Lagi, Filippo, Lobreglio, Giambattista, Lombardi, Andrea, Lupo, Laura Isabella, Luzzati, Roberto, Maraolo, Alberto Enrico, Mikulska, Malgorzata, Mondelli, Mario Umberto, Mularoni, Alessandra, Mussini, Cristina, Oliva, Alessandra, Pandolfo, Alessandro, Rogati, Carlotta, Trapani, Filippo Fabio, Venditti, Mario, Viale, Pierluigi, Caraffa, Emanuela, Cataldo, Maria Adriana, Granata G., Petrosillo N., Adamoli L., Bartoletti M., Bartoloni A., Basile G., Bassetti M., Bonfanti P., Borromeo R., Ceccarelli G., De Luca A.M., Di Bella S., Fossati S., Franceschini E., Gentile I., Giacobbe D.R., Giacometti E., Ingrassia F., Lagi F., Lobreglio G., Lombardi A., Lupo L.I., Luzzati R., Maraolo A.E., Mikulska M., Mondelli M.U., Mularoni A., Mussini C., Oliva A., Pandolfo A., Rogati C., Trapani F.F., Venditti M., Viale P., Caraffa E., and Cataldo M.A.

Subjects
medicine.medical_specialty, recurrence, genetic structures, lcsh:Medicine, Logistic regression, Clostridioides difficile, Article, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, risk factors, 030212 general & internal medicine, Risk factor, Prospective cohort study, 0303 health sciences, Adult patients, 030306 microbiology, business.industry, Incidence (epidemiology), Mortality rate, lcsh:R, General Medicine, risk factor, outcome, incidence, business, Clostridioides, Cohort study
Abstract

Background: Limited and wide-ranging data are available on the recurrent Clostridioides difficile infection (rCDI) incidence rate. Methods: We performed a cohort study with the aim to assess the incidence of and risk factors for rCDI. Adult patients with a first CDI, hospitalized in 15 Italian hospitals, were prospectively included and followed-up for 30 d after the end of antimicrobial treatment for their first CDI. A case–control study was performed to identify risk factors associated with 30-day onset rCDI. Results: Three hundred nine patients with a first CDI were included in the study, 32% of the CDI episodes (99/309) were severe/complicated, complete follow-up was available for 288 patients (19 died during the first CDI episode, and 2 were lost during follow-up). At the end of the study, the crude all-cause mortality rate was 10.7% (33 deaths/309 patients). Two hundred seventy-one patients completed the follow-up, rCDI occurred in 21% of patients (56/271) with an incidence rate of 72/10,000 patient-days. Logistic regression analysis identified exposure to cephalosporin as an independent risk factor associated with rCDI (RR: 1.7, 95% CI: 1.1–2.7, p = 0.03). Conclusion: Our study confirms the relevance of rCDI in terms of morbidity and mortality and provides a reliable estimation of its incidence.

Published
2020

3. Ceftolozane/Tazobactam for Treatment of Severe ESBL-Producing

Author

Bassetti, M., Vena, A., Giacobbe, D. R., Falcone, M., Tiseo, G., Giannella, M., Pascale, R., Meschiari, M., Digaetano, M., Oliva, A., Rovelli, C., Carannante, N., Losito, A. R., Carbonara, S., Mariani, M. F., Mastroianni, A., Angarano, G., Tumbarello, M., Tascini, C., Grossi, P., Mastroianni, C. M., Mussini, C., Viale, P., Menichetti, F., Viscoli, C., Russo, A., Verdenelli, S., Fabiani, S., Castaldo, N., Pecori, D., Carnellutti, A., Givone, F., Graziano, E., Merelli, M., Cadeo, B., Peghin, M., Cattelan, A., Cipriani, L., Coletto, D., Gianluca, R., Ciardi, M. R., Ajassa, C., Tieghi, T., Pontino, P., Raffaelli, F., Artioli, S., Caruana, G., Luzzati, R., Bontempo, G., Petrosillo, N., Capone, A., Rizzardini, G., Coen, M., Passerini, M., Guadagnino, G., Urso, F., Borgia, G., Gentile, I., Maraolo, A. E., Crapis, M., Venturini, S., Parruti, G., Trave, F., Girardis, M., Cascio, A., Gioe, C., Anselmo, M., Malfatto, E., Bassetti, Matteo, Vena, Antonio, Giacobbe, Daniele Roberto, Falcone, Marco, Tiseo, Giusy, Giannella, Maddalena, Pascale, Renato, Meschiari, Marianna, Digaetano, Margherita, Oliva, Alessandra, Rovelli, Cristina, Carannante, Novella, Losito, Angela Raffaella, Carbonara, Sergio, Mariani, Michele Fabiano, Mastroianni, Antonio, Angarano, Gioacchino, Tumbarello, Mario, Tascini, Carlo, Grossi, Paolo, Mastroianni, Claudio Maria, Mussini, Cristina, Viale, Pierluigi, Menichetti, Francesco, Viscoli, Claudio, Russo, Alessandro, Bassetti M., Vena A., Giacobbe D.R., Falcone M., Tiseo G., Giannella M., Pascale R., Meschiari M., Digaetano M., Oliva A., Rovelli C., Carannante N., Losito A.R., Carbonara S., Mariani M.F., Mastroianni A., Angarano G., Tumbarello M., Tascini C., Grossi P., Mastroianni C.M., Mussini C., Viale P., Menichetti F., Viscoli C., Russo A., Verdenelli S., Fabiani S., Castaldo N., Pecori D., Carnellutti A., Givone F., Graziano E., Merelli M., Cadeo B., Peghin M., Cattelan A., Cipriani L., Coletto D., Gianluca R., Ciardi M.R., Ajassa C., Tieghi T., Pontino P., Raffaelli F., Artioli S., Caruana G., Luzzati R., Bontempo G., Petrosillo N., Capone A., Rizzardini G., Coen M., Passerini M., Guadagnino G., Urso F., Borgia G., Gentile I., Maraolo A.E., Crapis M., Venturini S., Parruti G., Trave F., Girardis M., Cascio A., Gioe C., Anselmo M., Malfatto E., Russo, Alessandro &amp, and Luzzati, R.

Subjects
medicine.medical_specialty, ceftolozane/tazobactam, medicine.medical_treatment, CRRT, Tazobactam, Enterobacterales, Enterobacterale, Internal medicine, ESBL, septic shock, Major Article, medicine, Clinical endpoint, Renal replacement therapy, business.industry, Septic shock, Retrospective cohort study, Odds ratio, medicine.disease, Ceftolozane/tazobactam, AcademicSubjects/MED00290, Infectious Diseases, Oncology, Ceftolozane, business, Empiric therapy, medicine.drug
Abstract

Background Few data are reported in the literature about the outcome of patients with severe extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) infections treated with ceftolozane/tazobactam (C/T), in empiric or definitive therapy. Methods A multicenter retrospective study was performed in Italy (June 2016–June 2019). Successful clinical outcome was defined as complete resolution of clinical signs/symptoms related to ESBL-E infection and lack of microbiological evidence of infection. The primary end point was to identify predictors of clinical failure of C/T therapy. Results C/T treatment was documented in 153 patients: pneumonia was the most common diagnosis (n = 46, 30%), followed by 34 cases of complicated urinary tract infections (22.2%). Septic shock was observed in 42 (27.5%) patients. C/T was used as empiric therapy in 46 (30%) patients and as monotherapy in 127 (83%) patients. Favorable clinical outcome was observed in 128 (83.7%) patients; 25 patients were considered to have failed C/T therapy. Overall, 30-day mortality was reported for 15 (9.8%) patients. At multivariate analysis, Charlson comorbidity index >4 (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.9–3.5; P = .02), septic shock (OR, 6.2; 95% CI, 3.8–7.9; P < .001), and continuous renal replacement therapy (OR, 3.1; 95% CI, 1.9–5.3; P = .001) were independently associated with clinical failure, whereas empiric therapy displaying in vitro activity (OR, 0.12; 95% CI, 0.01–0.34; P < .001) and adequate source control of infection (OR, 0.42; 95% CI, 0.14–0.55; P < .001) were associated with clinical success. Conclusions Data show that C/T could be a valid option in empiric and/or targeted therapy in patients with severe infections caused by ESBL-producing Enterobacterales. Clinicians should be aware of the risk of clinical failure with standard-dose C/T therapy in septic patients receiving CRRT.

Published
2020

4. Use of colistin in adult patients: a cross-sectional study

Author

Giacobbe, Daniele Roberto, Saffioti, Carolina, Losito, Angela Raffaella, Rinaldi, Matteo, Aurilio, Caterina, Bolla, Cesare, Boni, Silvia, Borgia, Guglielmo, Carannante, Novella, Cassola, Giovanni, Ceccarelli, Giancarlo, Corcione, Silvia, Gasperina, Daniela Dalla, De Rosa, Francesco Giuseppe, Dentone, Chiara, Di Bella, Stefano, Di Lauria, Nicoletta, Feasi, Marcello, Fiore, Marco, Fossati, Sara, Franceschini, Erica, Gori, Andrea, Granata, Guido, Grignolo, Sara, Grossi, Paolo Antonio, Guadagnino, Giuliana, Lagi, Filippo, Maraolo, Alberto Enrico, Marinò, Valeria, Mazzitelli, Maria, Mularoni, Alessandra, Oliva, Alessandra, Pace, Maria Caterina, Parisini, Andrea, Patti, Francesca, Petrosillo, Nicola, Pota, Vincenzo, Raffaelli, Francesca, Rossi, Marianna, Santoro, Antonella, Tascini, Carlo, Torti, Carlo, Trecarichi, Enrico Maria, Venditti, Mario, Viale, Pierluigi, Signori, Alessio, Del Bono, Valerio, Giannella, Maddalena, Mikulska, Malgorzata, Tumbarello, Mario, Viscoli, Claudio, Passavanti, Maria Beatrice, Rogati, C, Sansone, Pasquale, Sarteschi, G, Roberto Giacobbe, Daniele, Saffioti1, Carolina, Raffaella Losito, Angela, Rinaldi, Matteo, Aurilio, Caterina, Bolla, Cesare, Boni, Silvia, Borgia, Guglielmo, Carannante, Novella, Cassola, Giovanni, Ceccarelli, Giancarlo, Corcione, Silvia, Dalla Gasperina, Daniela, Giuseppe De Rosa, Francesco, Dentone, Chiara, DI BELLA, Stefano, Di Lauria, Nicoletta, Feasi, Marcello, Fiore, Marco, Fossati, Sara, Franceschini, Erica, Gori, Andrea, Granata, Guido, Grignolo, Sara, Antonio Grossi, Paolo, Guadagnino, Giuliana, Lagi, Filippo, Enrico Maraolo, Alberto, Marinò, Valeria, Mazzitelli, Maria, Mularoni, Alessandra, Oliva, Alessandra, Caterina Pace, Maria, Parisini, Andrea, Patti, Francesca, Petrosillo, Nicola, Pota, Vincenzo, Raffaelli, Francesca, Rossi, Marianna, Santoro, Antonella, Tascini, Carlo, Torti, Carlo, Maria Trecarichi, Enrico, Venditti, Mario, Viale, Pierluigi, Signori, Alessio, Bassetti, Matteo, Del Bono, Valerio, Giannella, Maddalena, Mikulska, Malgorzata, Tumbarello, Mario, Viscoli, Claudio, Giacobbe, Daniele Roberto, Saffioti, Carolina, Losito, Angela Raffaella, Gasperina, Daniela Dalla, De Rosa, Francesco Giuseppe, Di Bella, Stefano, Grossi, Paolo Antonio, Maraolo, Alberto Enrico, Pace, Maria Caterina, Trecarichi, Enrico Maria, Passavanti, Maria Beatrice, Rogati, C, Sansone, Pasquale, Sarteschi, G, Giacobbe D.R., Saffioti C., Losito A.R., Rinaldi M., Aurilio C., Bolla C., Boni S., Borgia G., Carannante N., Cassola G., Ceccarelli G., Corcione S., Dalla Gasperina D., De Rosa F.G., Dentone C., Di Bella S., Di Lauria N., Feasi M., Fiore M., Fossati S., Franceschini E., Gori A., Granata G., Grignolo S., Grossi P.A., Guadagnino G., Lagi F., Maraolo A.E., Marino V., Mazzitelli M., Mularoni A., Oliva A., Pace M.C., Parisini A., Patti F., Petrosillo N., Pota V., Raffaelli F., Rossi M., Santoro A., Tascini C., Torti C., Trecarichi E.M., Venditti M., Viale P., Signori A., Bassetti M., Del Bono V., Giannella M., Mikulska M., Tumbarello M., and Viscoli C.

Subjects
0301 basic medicine, Male, Endemic Diseases, Drug Resistance, Carbapenem-resistant enterobacteriaceae, Pseudomona, 0302 clinical medicine, Interquartile range, Levofloxacin, Drug Resistance, Multiple, Bacterial, Klebsiella, polycyclic compounds, Acinetobacter, Antimicrobial resistance, Colistimethate, Colistin, Pseudomonas, Administration, Intravenous, Aged, Anti-Bacterial Agents, Cross-Sectional Studies, Drug Prescriptions, Drug Therapy, Combination, Female, Gram-Negative Bacterial Infections, Humans, Italy, Middle Aged, Respiratory Tract Infections, Sepsis, Immunology and Allergy, 030212 general & internal medicine, colistin, colistimethate, Bacterial, QR1-502, Administration, Combination, lipids (amino acids, peptides, and proteins), antimicrobial resistance, Intravenous, Multiple, medicine.drug, Microbiology (medical), medicine.medical_specialty, Cefepime, 030106 microbiology, Immunology, Microbiology, Loading dose, 03 medical and health sciences, Drug Therapy, Internal medicine, Lower respiratory tract infection, medicine, business.industry, biochemical phenomena, metabolism, and nutrition, medicine.disease, business
Abstract

Objectives The aim of this study was to assess colistin use in a country endemic for multidrug-resistant Gram-negative bacteria (MDR-GNB). Methods Colistin prescription patterns were evaluated in 22 Italian centres. Factors associated with use of colistin in combination with other anti-MDR-GNB agents were also assessed. Results A total of 221 adults receiving colistin were included in the study. Their median age was 64 years (interquartile range 52–73 years) and 134 (61%) were male. Colistin was mostly administered intravenously (203/221; 92%) and mainly for targeted therapy (168/221; 76%). The most frequent indications for colistin therapy were bloodstream infection and lower respiratory tract infection. Intravenous colistin was administered in combination with at least another anti-MDR-GNB agent in 80% of cases (163/203). A loading dose of 9 MU of colistimethate was administered in 79% of patients receiving i.v. colistin and adequate maintenance doses in 85%. In multivariable analysis, empirical therapy [odds ratio (OR) = 3.25, 95% confidence interval (CI) 1.24–8.53;P = 0.017] and targeted therapy for carbapenem-resistant Enterobacterales infection (OR = 4.76, 95% CI 1.69–13.43; P = 0.003) were associated with use of colistin in combination with other agents, whilst chronic renal failure (OR = 0.39, 95% CI 0.17–0.88; P = 0.024) was associated with use of colistin monotherapy. Conclusion Colistin remains an important option for severe MDR-GNB infections when other treatments are not available. Despite inherent difficulties in optimising its use owing to peculiar pharmacokinetic/pharmacodynamic characteristics, colistin was mostly used appropriately in a country endemic for MDR-GNB.

Published
2020

5. A prospective multicentre study of the epidemiology and outcomes of bloodstream infection in cirrhotic patients

Author

Ivan Gentile, Jesús Rodríguez-Baño, Alia Eworo, Gloria Taliani, E. Nadal, M. Valerio, A. Beteta-Lopez, Christoph Schramm, Pierluigi Viale, Bruno Baršić, Cristina Badia, S. Ludovisi, Alberto Enrico Maraolo, Gabriella Verucchi, Elena Seminari, M. de Cueto, Maddalena Giannella, E. Boumis, S. Grieco, Pilar Retamar, Nazaret Cobos-Trigueros, Caterina Campoli, Emilio Bouza, Mauro Bernardi, Patrizia Burra, M. Varguvic, Sara K. Tedeschi, Esther Calbo, María Dolores González-Ripoll Navarro, N. Bar Sinai, Mario Venditti, Andreas Stallmach, Russell E. Lewis, Guglielmo Borgia, Patricia Muñoz, Antonio Riccardo Buonomo, Mical Paul, Gianpiero D'Offizi, Michele Bartoletti, Paolo Caraceni, M.A. Galan-Ladero, Mario Tumbarello, Manuela Merli, Marco Senzolo, G. Siccardi, R. Losito, A. Ottobrelli, E. Lopez Cortes, A. Rianda, Cristina Lucidi, Simone Ambretti, Nicola Petrosillo, M. Torrani Cerenzia, Tony Bruns, Bartoletti, M., Giannella, M., Lewis, R., Caraceni, P., Tedeschi, S., Paul, M., Schramm, C., Bruns, T., Merli, M, Cobos-Trigueros, N., Seminari, E., Retamar, P., Muñoz, P., Tumbarello, M., Burra, P., Torrani Cerenzia, M., Barsic, B., Calbo, E., Maraolo, A.E., Petrosillo, N., Galan-Ladero, M.A., D'Offizi, G., Bar Sinai, N., Rodríguez-Baño, J., Verucchi, G., Bernardi, M., Viale, P., Bartoletti, M, Giannella, M, Lewis, R, Caraceni, P, Tedeschi, S, Paul, M, Schramm, C, Bruns, T, Cobos-trigueros, N, Seminari, E, Retamar, P, Muñoz, P, Tumbarello, M, Burra, P, Torrani Cerenzia, M, Barsic, B, Calbo, E, Maraolo, Ae, Petrosillo, N, Galan-ladero, Ma, D'Offizi, G, Bar Sinai, N, Rodríguez-baño, J, Verucchi, G, Bernardi, M, Viale, P, Campoli, C, Siccardi, G, Ambretti, S, Stallmach, A, Venditti, M, Lucidi, C, Ludovisi, S, De Cueto, M, Navarro, Md, Lopez Cortes, E, Bouza, E, Valerio, M, Eworo, A, Losito, R, Senzolo, M, Nadal, E, Ottobrelli, A, Varguvic, M, Badia, C, Borgia, G, Gentile, I, Buonomo, Ar, Boumis, E, Beteta-lopez, A, Rianda, A, Taliani, G, and Grieco, S.

Subjects
Liver Cirrhosis, Male, Microbiology (medical), medicine.medical_specialty, Multidrug-resistant pathogen, Comorbidity, Bloodstream infection, Bacterial infections, Bloodstream infections, CLIF-SOFA, Multidrug-resistant pathogens, Logistic regression, Liver cirrhosi, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Sepsis, Internal medicine, Epidemiology, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Mortality, Risk factor, Intensive care medicine, Prospective cohort study, Aged, Proportional hazards model, business.industry, Liver cirrhosis, Infectious Diseases, Mortality rate, Hazard ratio, Disease Management, Drug Resistance, Microbial, General Medicine, Middle Aged, Prognosis, Patient Outcome Assessment, Population Surveillance, Female, 030211 gastroenterology & hepatology, Bacterial infection, business, Cohort study
Abstract

ESGBIS/BICHROME Study Group: C. Campoli, G. Siccardi, S. Ambretti, A. Stallmach, M. Venditti, C. Lucidi, S. Ludovisi, M. De Cueto, M. D. Navarro, E. Lopez Cortes, E. Bouza, M. Valerio, A. Eworo, R. Losito, M. Senzolo, E. Nadal, A. Ottobrelli, M. Varguvic, C. Badia, G. Borgia, I. Gentile, A. R. Buonomo, E. Boumis, A. Beteta-Lopez, A. Rianda, G. Taliani, S. Grieco., [Objectives] To describe the current epidemiology of bloodstream infection (BSI) in patients with cirrhosis; and to analyse predictors of 30-day mortality and risk factors for antibiotic resistance., [Methods] Cirrhotic patients developing a BSI episode were prospectively included at 19 centres in five countries from September 2014 to December 2015. The discrimination of mortality risk scores for 30-day mortality were compared by area under the receiver operator risk and Cox regression models. Risk factors for multidrug-resistant organisms (MDRO) were assessed with a logistic regression model., [Results] We enrolled 312 patients. Gram-negative bacteria, Gram-positive bacteria and Candida spp. were the cause of BSI episodes in 53%, 47% and 7% of cases, respectively. The 30-day mortality rate was 25% and was best predicted by the Sequential Organ Failure Assessment (SOFA) and Chronic Liver Failure–SOFA (CLIF-SOFA) score. In a Cox regression model, delayed (>24 hours) antibiotic treatment (hazard ratio (HR) 7.58; 95% confidence interval (CI) 3.29–18.67; p < 0.001), inadequate empirical therapy (HR 3.14; 95% CI 1.93–5.12; p < 0.001) and CLIF-SOFA score (HR 1.35; 95% CI 1.28–1.43; p < 0.001) were independently associated with 30-day mortality. Independent risk factors for MDRO (31% of BSIs) were previous antimicrobial exposure (odds ratio (OR) 2.91; 95% CI 1.73–4.88; p < 0.001) and previous invasive procedures (OR 2.51; 95% CI 1.48–4.24; p 0.001), whereas spontaneous bacterial peritonitis as BSI source was associated with a lower odds of MDRO (OR 0.30; 95% CI 0.12–0.73; p 0.008)., [Conclusions] MDRO account for nearly one-third of BSI in cirrhotic patients, often resulting in delayed or inadequate empirical antimicrobial therapy and increased mortality rates. Our data suggest that improved prevention and treatment strategies for MDRO are urgently needed in the liver cirrhosis patients.

Published
2018

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