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Combatting antimicrobial resistance critical for patients with cirrhosis

Worldwide public health concerns over antimicrobial resistance in pathogenic bacteria make it important to find solutions for preventing the spread of resistant bacteria, particularly for patients with cirrhosis who are highly susceptible to developing infection, according to findings published in the Journal of Hepatology.

“Hepatologists face a dilemma between escalating antibiotic use that may further spread resistance and restricting antibiotic use with potentially unfavorable outcomes,” Javier Fernández, MD, PhD, of the liver unit at the Hospital Clínic in Spain, and colleagues wrote. “Given the global health burden caused by cirrhosis in society, corresponding to 14 to 26 new cases per 100,000 inhabitants and 170,000 deaths per year in Europe, this issue is relevant not only to the clinical management of patients with cirrhosis but also to the global public health crisis of antimicrobial resistance.”

Researchers cited frequent hospital trips and antibiotic exposure as the main avenues for patients with cirrhosis to develop infection. In addition, they noted improper antibiotic schedules can lead to increased morbidity, such as acute kidney injury and acute-on-chronic liver injury, which could eventually lead to hospital mortality.

Of further concern, is that current definitions of multidrug resistance (MDR) are intended for epidemiologic reasons and not appropriate when used by medical professionals in day-to-day procedures, according to the researchers.

“A more clinically relevant approach is to define MDR as resistance to one key antimicrobial category that is recommended and widely used for the treatment of infected patients,” researchers wrote.

To keep multidrug resistance organisms (MDRO) from growing, Fernández and colleagues offered several suggestions. First, they recommend instilling stool from a healthy person into the intestines of a patient with cirrhosis. Using tests that find antimicrobial resistance faster, such as testing the likelihood of positive culture broths for MDRO or matrix-assisted liver desorption/ionization time-of-flight mass spectrometry may be helpful. Further, they advise adopting a regular schedule of checking nasal and rectal areas. Next, provide hospitals with positive reasons for using antibiotics properly and take swift action when MDRO are discovered. Finally, administer third-generation cephalosporins when an infection occurs in the community and apply piperacillin-tazobactam when the infection takes place in the health care system.

“Nowadays, hepatologists must face a complex clinical scenario that requires new empirical antibiotic strategies that may further spread resistance,” Fernandez and colleagues wrote. “Global, regional and local preventive measures should therefore be implemented to combat antimicrobial resistance in cirrhosis.” – by Janel Miller

Disclosure: Healio.com/Hepatology was unable to determine relevant financial disclosures at the time of publication.