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Impact of multidrug resistance on the management of bacterial infections in cirrhosis

World Journal of Clinical Cases 2023年第3期11卷 534-544页

作者： carlos Terra Ângelo Zambam de Mattos Marcelo Souza Chagas Andre Torres Denusa Wiltgen Barbara Muniz Souza Renata mello Perez gastroenterology-Liver Unit State University of Rio de JaneiroRio de Janeiro 20551-030Rio de JaneiroBrazil Liver Unit Casa de Saúde São José-Rede Santa CatarinaRio de Janeiro 22271-080Rio de JaneiroBrazil Alliance of Brazilian Centers for Cirrhosis car The ABC GroupRio de Janeiro 20551-030Rio de JaneiroBrazil Liver Unit Federal Hospital of LagoaRio de Janeiro 22470-050Rio de JaneiroBrazil graduate Program in Medicine:Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil gastroenterology and Hepatology Unit Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil Internal Medicine Federal Hospital of LagoaRio de Janeiro 22470-050Rio de JaneiroBrazil Department of Internal Medicine Federal University of Health Sciences of Porto AlegrePorto Alegre 90020-090Brazil Hepatology Division Federal University of Rio de JaneiroRio de Janeiro 21941-617Rio de JaneiroBrazil IDOR D’Or Institute for Research and EducationRio de Janeiro 22281-100Rio de JaneiroBrazil

Patients with cirrhosis have an increased risk of infection and differently from other complications,that over the years are improving in their outcomes,infections in cirrhotic patients are still a major cause of hospitalization and death(up to 50%in-hospital mortality).Infections by multidrug-resistant organisms(MDRO)have become a major challenge in the management of cirrhotic patients with significant prognostic and cost-related *** one third of cirrhotic patients with bacterial infections is infected with MDR bacteria and their prevalence has increased in recent *** infections have a worse prognosis compared to infections by non-resistant bacteria because they are associated with lower rate of infection *** adequate management of cirrhotic patients with infections caused by MDR bacteria depends on the knowledge of some epidemiological aspects,such as the type of infection(spontaneous bacterial peritonitis,pneumonia,urinary tract infection and spontaneous bacteremia),bacteriological profile of antibiotic resistance at each health care unit and site of infection acquisition(community acquired,healthcare associated or nosocomial).Furthermore,regional variations in the prevalence of MDR infections determine that the choice of empirical antibiotic therapy must be adapted to the local microbiological *** treatment is the most effective measure to treat infections caused by ***,optimizing antibiotic prescribing is critical to effectively treat these *** of risk factors for multidrug resistance is essential to define the best antibiotic treatment strategy in each case and the choice of an effective empirical antibiotic therapy and its early administration is cardinal to reduce *** the other hand,the supply of new agents to treat these infections is very ***,specific protocols that include preventive measures must be implemented in order to limit the negative impact of this sev

关键词： Cirrhosis Infection Multidrug-resistance Bacterial Antibiotics Microbiota

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