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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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Can gadoxetic acid–enhanced magnetic resonance imaging be used to avoid liver biopsy in patients with nonalcoholic fatty liver disease?

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World Journal of Hepatology 2020年第9期12卷 661-671页

作者： Viviane Brandão Amorim Daniella Braz Parente Fernando Fernandes Paiva Jaime Araújo Oliveira Neto Amanda Almeida Miranda Cláudia Cravo Moreira Flávia Ferreira Fernandes Carlos Frederico FerreiraCampos Nathalie Carvalho Leite renata de mello perez Rosana Souza Rodrigues Research Department D’Or Institute for Research and EducationRio de Janeiro 22281Brazil Radiology Department Brazilian National Cancer InstituteRio de Janeiro 20230-130Brazil Radiology Department Fleury Group S.A.Rio de Janeiro 20765-000Brazil Radiology Department Hospital Universitário Clementino Fraga FilhoFederal University of Rio de JaneiroRio de Janeiro 21941-590Brazil São Carlos Institute of Physics University of São PauloSão Carlos 13560-970Brazil Radiology Department Quinta D'Or HospitalRio de Janeiro 20941-150Brazil Radiology Department Centro de Diagnóstico Médico do MaranhãoMaranhão 65074-441Brazil Department of Clinical Medicine Hospital Universitário Clementino Fraga FilhoFederal University of Rio de JaneiroRio de Janeiro 21941-590Brazil Gastroenterology and Hepatology Department Hospital Federal de BonsucessoRio de Janeiro 21041-030Brazil Department of Pathology and Laboratories University of the State of Rio de JaneiroRio de Janeiro 20551-030Brazil Internal Medicine Department Hospital Universitário Clementino Fraga FilhoFederal University of Rio de JaneiroRio de Janeiro 21941-590Brazil Gastroenterology Department Hospital Universitário Pedro ErnestoUniversity of the State of Rio de JaneiroRio de Janeiro 20551-030Brazil

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is a major cause of liver disease *** diagnosis of nonalcoholic steatohepatitis(NASH),the most severe form of NAFLD,is crucial and has prognostic and therapeutic ***,currently this diagnosis is based on liver biopsy and has several *** To evaluate the performance of gadoxetic acid–enhanced magnetic resonance imaging(GA-MRI)in differentiating isolated steatosis from NASH in patients with *** In this prospective study,56 patients with NAFLD(18 with isolated steatosis and 38 with NASH)underwent *** contrast enhancement index(CEI)was calculated as the rate of increase of the liver-to-muscle signal intensity ratio from before and 20 min after intravenous GA ***-group differences in mean CEI were examined using Student's t *** area under the receiver operator characteristic curve and the diagnostic performance of gadoxetic acid–enhanced magnetic resonance imaging were *** The mean CEI for all subjects was 1.82±*** mean CEI was significantly lower in patients with NASH than in those with isolated steatosis(P=0.008).Two CEI cut-off points were used:2.00(89%sensitivity)to characterize isolated *** values between 1.66 and 2.00 indicated liver biopsy,and the procedure could be avoided in 40%of patients with *** GA-MRI is an effective noninvasive method that may be useful for the differentiation of NASH from isolated steatosis,and could help to avoid liver biopsy in patients with NAFLD.

关键词： Fatty liver Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Gadoxetic

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Fibrosis assessment using Fibro Meter combined to first generation tests in hepatitis C

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World Journal of Hepatology 2017年第6期9卷 310-317页

作者： Maria Chiara Chindamo Jerome Boursier Ronir Raggio Luiz Isabelle Fouchard-Hubert Vera Lúcia Nunes Pannain Joao Marcello de Araújo Neto Henrique Sérgio Moraes Coelho renata de mello perez Paul Calès Cristiane Alves Villela-Nogueira Departament of Internal Medicine Federal University of Rio de Janeiro Department of Hepatology University Hospital HIFIH Laboratory UPRES 3859SFR 4208Bretagne Loire University Institute of Public Health Studies Federal University of Rio de Janeiro Departament of Pathology Federal University of Rio de Janeiro Gastroenterology Department University of the State of Rio de Janeiro D’Or Institute for Research and Education

AIMTo evaluate the performance of FibroMeterVirus3G combined to the first generation tests aspartate aminotransferase-to-platelet ratio index (APRI) or Forns index to assess significant fibrosis in chronic hepatitis C (CHC). METHODSFirst generation tests APRI or Forns were initially applied in a derivation population from Rio de Janeiro in Brazil considering cut-offs previously reported in the literature to evaluate significant fibrosis. FibroMeterVirus3G was sequentially applied to unclassified cases from APRI or Forns. Accuracy of non-invasive combination of tests, APRI plus FibroMeterVirus3G and Forns plus FibroMeterVirus3G was evaluated in the Brazilian derivation population. APRI plus FibroMeterVirus3G combination was validated in a population of CHC patients from Angers in France. All patients were submitted to liver biopsy staged according to METAVIR score by experienced hepatopathologists. Significant fibrosis was considered as METAVIR F ≥ 2. The fibrosis stage classification was used as the reference for accuracy evaluation of non-invasive combination of tests. Blood samples for the calculation of serum tests were collected on the same day of biopsy procedure or within a maximum 3 mo interval and stored at -70 °C. RESULTSSeven hundred and sixty CHC patients were included (222 in the derivation population and 538 in the validation group). In the derivation population, the FibroMeterVirus3G AUROC was similar to APRI AUROC (0.855 vs 0.815, P = 0.06) but higher than Forns AUROC (0.769, P Virus3G cut-off to discriminate significant fibrosis was 0.61 (80% diagnostic accuracy; 75% in the validation population, P = 0.134). The sequential combination of APRI or Forns with FibroMeterVirus3G in derivation population presented similar performance compared to FibroMeterVirus3G used alone (79% vs 78% vs 80%, respectively, P = 0.791). Unclassified cases of significant fibrosis af

关键词： Chronic hepatitis C Fibrosis Liver biopsy Non-invasive methods FibroMeterVirus3G Combination algorithms

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