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Multicenter Study
. 2024 Nov;44(11):2915-2928.
doi: 10.1111/liv.16063. Epub 2024 Aug 15.

Development and external validation of a model to predict multidrug-resistant bacterial infections in patients with cirrhosis

Sebastián Marciano  1 , Salvatore Piano  2 , Virendra Singh  3 , Paolo Caraceni  4   5 , Rakhi Maiwall  6 , Carlo Alessandria  7 , Javier Fernandez  8   9   10   11 , Dong Joon Kim  12 , Sung Eun Kim  13 , Elza Soares  14 , Mónica Marino  15 , Julio Vorobioff  16 , Manuela Merli  17 , Laure Elkrief  18 , Victor Vargas  19 , Aleksander Krag  20 , Shivaram Singh  21 , Martín Elizondo  22 , Maria M Anders  23 , Melisa Dirchwolf  24 , Manuel Mendizabal  25 , Cosmas R A Lesmana  26   27   28 , Claudio Toledo  29 , Florence Wong  30 , Francois Durand  31 , Adrián Gadano  1 , Diego H Giunta  32 , Paolo Angeli  2 ; International Club of Ascites Global Study Group
Affiliations
Multicenter Study

Development and external validation of a model to predict multidrug-resistant bacterial infections in patients with cirrhosis

Sebastián Marciano et al. Liver Int. 2024 Nov.

Abstract

With the increasing rate of infections caused by multidrug-resistant organisms (MDRO), selecting appropriate empiric antibiotics has become challenging. We aimed to develop and externally validate a model for predicting the risk of MDRO infections in patients with cirrhosis.

Methods: We included patients with cirrhosis and bacterial infections from two prospective studies: a transcontinental study was used for model development and internal validation (n = 1302), and a study from Argentina and Uruguay was used for external validation (n = 472). All predictors were measured at the time of infection. Both culture-positive and culture-negative infections were included. The model was developed using logistic regression with backward stepwise predictor selection. We externally validated the optimism-adjusted model using calibration and discrimination statistics and evaluated its clinical utility.

Results: The prevalence of MDRO infections was 19% and 22% in the development and external validation datasets, respectively. The model's predictors were sex, prior antibiotic use, type and site of infection, MELD-Na, use of vasopressors, acute-on-chronic liver failure, and interaction terms. Upon external validation, the calibration slope was 77 (95% CI .48-1.05), and the area under the ROC curve was .68 (95% CI .61-.73). The application of the model significantly changed the post-test probability of having an MDRO infection, identifying patients with nosocomial infection at very low risk (8%) and patients with community-acquired infections at significant risk (36%).

Conclusion: This model achieved adequate performance and could be used to improve the selection of empiric antibiotics, aligning with other antibiotic stewardship program strategies.

Keywords: antibacterial agents; antibiotic resistance; antimicrobial stewardship; cirrhosis; clinical decision making; empirical antibiotic treatment.

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References

REFERENCES

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