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Broad spectrum antibiotic therapy improves survival in cirrhosis

Broad spectrum antibiotic treatment was more effective and improved survival compared with standard therapy in patients with cirrhosis with health care–associated infections, according to new study data published in Hepatology.

“Our study showed that a broad spectrum antibiotic therapy as empirical treatment in [health care–associated] infections improves survival in cirrhosis,” Manuela Merli, MD, of the division of gastroenterology, Sapienza Universita' di Roma, Italy, told Healio.com/Hepatology. “This treatment was significantly effective, safe and cost-saving.” 

To compare the safety and effectiveness of an empirical broad spectrum antibiotic therapy with standard therapy, Merli and colleagues prospectively evaluated 94 consecutive patients with cirrhosis hospitalized with health care–associated infections. The researchers randomly assigned them to one of two empirical antibiotic treatment groups: standard therapy based on third-generation cephalosporins or broad spectrum antibiotic treatment based on carbapenems, alone or in combination with other antibiotics. The primary endpoint of the study was in-hospital mortality.

Manuela Merli

“Health care–associated infections are still usually treated as community-acquired. As a consequence, the rate of failure of empirical antibiotic treatment is increasing,” Merli said.

Results showed broad spectrum treatment had a lower rate of failure (18%) compared with standard therapy (51%; P = .001). In addition, in-hospital mortality rate was lower in patients who received broad spectrum therapy (6% vs. 25%; P = .01) and length of hospital stay was shorter (12.3±7 days vs. 18±15 days; P = .03) compared with standard therapy.

Higher mortality in the standard group of patients was observed for all types of infections compared with the broad spectrum-treated group, including urinary tract infection (21% vs. 0%), pneumonia (30% vs. 20%) and spontaneous bacterial peritonitis (33% vs. 11%).

Both groups had high prevalence of multi-drug resistant pathogens; 40% in the standard group and 46% in the broad spectrum group, according to Merli. Five patients in each group developed a second infection during hospitalization. However, broad spectrum antibiotics did not increase the prevalence of multi-drug resistant pathogens in the second infection (50%) whereas standard therapy did (60%).

“The results of the present study suggest how to optimize the empirical antibiotic therapy in [health care–associated] infections in patients with cirrhosis; this is a crucial point given that the main relevant infections in these patients are often culture-negative, which does not allow a targeted therapy,” Merli and colleagues wrote. “Any delay in the start of therapy during a bacterial infection may prove to be detrimental.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.