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Cirrhotic patients taking systemic antibiotics pre-infection more likely to develop AR-BI

Hospitalized patients with cirrhosis exposed to systemic antibiotics within 30 days before infection, but not oral nonabsorbed antibiotics, showed a strong prevalence of antibiotic-resistant bacterial infections in a recent investigation.

To predict antibiotic-resistant bacterial infections (AR-BI), researchers identified 115 unique patients (mean age, 55.6 years; 68% men) hospitalized at Yale New Haven Hospital with cirrhosis and bacterial infections between July 2009 and November 2010. Urinary tract (32%) and spontaneous bacterial peritonitis (24%) were the most common infections, and 30% were nosocomial infections that developed more than 48 hours after hospital admission. Infection occurred in 36% of patients exposed 30 days beforehand to systemic antibiotics, including quinolones, piperacillin-tazobactam and/or third-generation cephalosporin. Twenty-four percent of patients had been exposed only to oral nonabsorbed antibiotics (primarily rifaximin) within 30 days.

Using univariate analysis researchers learned that patients’ exposure to both systemic and nonabsorbed antibiotics significantly predicted AR-BI (OR=7.7; 95% CI, 2.2-26.1). Assessed separately as systemic antibiotics, oral nonabsorbed antibiotics or no antibiotic exposure, only systemic drugs taken within 30 days indicated a significant risk for AR-BI (OR=13.5; 95% CI, 2.6-71.6). Oral nonabsorbed antibiotics showed no association with AR-BI (OR=0.4; 95% CI, 0.04-0.28).

In a secondary sensitivity analysis of 169 bacterial infections among the patients, associations were found between AR-BI and nosocomial infection (OR=4.2; 95% CI, 1.4-12.5) and exposure to systemic antibiotics and AR-BI (OR=5.2; 95% CI, 1.5-17.7).

“This study showed a high rate of antibiotic-resistant bacterial infections in patients with cirrhosis hospitalized in a tertiary transplant center,” the investigators concluded. “We found that prior exposure to systemic antibiotics is the most important predictor of the development of these infections. … In the most commonly seen infections, both recent antibiotic exposure and nosocomial acquisition of infection are predictors of resistance to empiric antibiotic therapy.”