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Clin Gastroenterol Hepatol. 2015 Apr;13(4):753-9.e1-2. doi: 10.1016/j.cgh.2014.07.060. Epub 2014 Aug 12.

Long-term use of antibiotics and proton pump inhibitors predict development of infections in patients with cirrhosis.

Author information

1
Medicine, Baylor University Medical Center, Dallas, Texas. Electronic address: Jacquelo@BaylorHealth.edu.
2
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
3
Medicine, University of Toronto, Toronto, Ontario, Canada.
4
Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota.
5
Medicine, University of California, San Diego, San Diego, California.
6
Medicine, University of Colorado, Denver, Colorado.
7
Medicine, University of Texas Health Science Center, Houston, Texas.
8
Medicine, Yale University School of Medicine, New Haven, Connecticut.
9
Medicine, Emory University, Atlanta, Georgia.
10
Medicine, Beth Israel Deaconess, Boston, Massachusetts.
11
Biostatistics, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia.
12
Medicine, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia.

Abstract

BACKGROUND & AIMS:

Bacterial infections, particularly repeated infections, are significant causes of morbidity and mortality among patients with cirrhosis. We investigated and characterized risk factors for repeat infections in these patients.

METHODS:

In a prospective study, we collected data from 188 patients hospitalized with cirrhosis and infections and enrolled in the North American Consortium for the Study of End-Stage Liver Disease (12 centers). Patients were followed up for 6 months after hospital discharge and data were analyzed on type of infections and factors associated with subsequent infections.

RESULTS:

Six months after hospital discharge, 14% of subjects had received liver transplants, 27% died, and 59% were alive without liver transplantation. After discharge, 45% had subsequent infections, but only 26% of the subsequent infections occurred at the same site. Compared with patients not re-infected, patients with repeat infections were older and a higher proportion used proton pump inhibitors (PPIs) (P = .006), rifaximin (P < .001), or prophylactic therapy for spontaneous bacterial peritonitis (SBP) (P < .001). Logistic regression showed that SBP prophylaxis (odds ratio [OR], 3.44; 95% confidence interval [CI], 1.56-7.63), PPI use (OR, 2.94; 95% CI, 1.39-6.20), SBP at hospital admission (OR, 0.37; 95% CI, 0.15-0.91), and age (OR, 1.06; 95% CI, 1.02-1.11) were independent predictors of subsequent infections.

CONCLUSIONS:

Patients hospitalized with cirrhosis and infections are at high risk for subsequent infections, mostly at different sites, within 6 months of index infection resolution. Those at highest risk include previously infected older patients receiving PPIs and/or SBP prophylaxis, although these associations do not prove that these factors cause the infections. New strategies are needed to prevent infections in patients with cirrhosis.

KEYWORDS:

Antibiotic; Complication; Decompensation; NACSELD

PMID:
25130937
PMCID:
PMC4326601
DOI:
10.1016/j.cgh.2014.07.060
[Indexed for MEDLINE]
Free PMC Article

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