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. 2024 May 1;79(5):1019-1032.
doi: 10.1097/HEP.0000000000000653. Epub 2023 Dec 1.

Determinants of clinical response to empirical antibiotic treatment in patients with cirrhosis and bacterial and fungal infections-Results from the ICA "Global Study" (EABCIR-Global Study)

Rakhi Maiwall  1 , Salvatore Piano  2 , Virendra Singh  3 , Paolo Caraceni  4 , Carlo Alessandria  5 , Javier Fernandez  6   7   8   9 , Elza Cotrim Soares  10 , Dong Joon Kim  11 , Sung Eun Kim  12 , Monica Marino  13 , Julio Vorobioff  14 , Rita de Cassia Ribeiro Barea  15 , Manuela Merli  16 , Laure Elkrief  17 , Victor Vargas  18 , Aleksander Krag  19 , Shivaram Prasad Singh  20 , Laurentius Adrianto Lesmana  21 , Claudio Toledo  22 , Sebastian Marciano  23 , Xavier Verhelst  24 , Florence Wong  25 , Nicolas Intagliata  26 , Liane Rabinowich  27 , Luis Colombato  28 , Sang Gyune Kim  29 , Alexander Gerbes  30 , Francois Durand  31 , Juan Pablo Roblero  32 , Kalyan Ram Bhamidimarri  33 , Marina Maevskaya  34 , Eduardo Fassio  35 , Hyoung Su Kim  36 , Jae Seok Hwang  37 , Pere Gines  6   7   8 , Tony Bruns  38   39 , Adrian Gadano  23 , Paolo Angeli  2 , Shiv Kumar Sarin  1 ; International Club of Ascites Global Study Group
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Determinants of clinical response to empirical antibiotic treatment in patients with cirrhosis and bacterial and fungal infections-Results from the ICA "Global Study" (EABCIR-Global Study)

Rakhi Maiwall et al. Hepatology. .

Abstract

Background: The administration of an appropriate empirical antibiotic treatment is essential in cirrhosis and severe bacterial infections. We aimed to investigate the predictors of clinical response of empirical antibiotic treatment in a prospective cohort of patients with cirrhosis and bacterial and fungal infections included in the International Club of Ascites "Global Study."

Methods: Patients hospitalized with cirrhosis and bacterial/fungal infection were prospectively enrolled at 46 centers. Clinical response to antibiotic treatment was defined according to changes in markers of infection/inflammation, vital signs, improvement of organ failure, and results of cultures.

Results: From October 2015 to September 2016, 1302 patients were included at 46 centers. A clinical response was achieved in only 61% of cases. Independent predictors of lack of clinical response to empirical treatment were C-reactive protein (OR = 1.16; 95% CI = 1.02-1.31), blood leukocyte count (OR = 1.39;95% CI = 1.09-1.77), serum albumin (OR = 0.70; 95% CI = 0.55-0.88), nosocomial infections (OR = 1.96; 95% CI = 1.20-2.38), pneumonia (OR = 1.75; 95% CI = 1.22-2.53), and ineffective treatment according to antibiotic susceptibility test (OR = 5.32; 95% CI = 3.47-8.57). Patients with a lack of clinical response to first-line antibiotic treatment had a significantly lower resolution rate of infections (55% vs. 96%; p < 0.001), a higher incidence of second infections (29% vs. 15%; p < 0.001), shock (35% vs. 7%; p < 0.001) and new organ failures (52% vs. 19 %; p < 0.001) than responders. Clinical response to empirical treatment was an independent predictor of 28-day survival ( subdistribution = 0.20; 95% CI = 0.14-0.27).

Conclusions: Four out of 10 patients with cirrhosis do not respond to the first-line antibiotic therapy, leading to lower resolution of infections and higher mortality. Broader-spectrum antibiotics and strategies targeting systemic inflammation may improve prognosis in patients with a high degree of inflammation, low serum albumin levels, and severe liver impairment.

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References

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