The impact of carbapenem resistance on clinical deterioration and mortality in patients with liver disease

Liver Int. 2017 Oct;37(10):1488-1496. doi: 10.1111/liv.13438. Epub 2017 May 20.

Abstract

Background & aims: Infections with multidrug-resistant gram-negative bacteria are significantly impairing the prognosis of patients with liver disease. In particular, carbapenem resistance further narrows therapeutic options. This study investigates the impact of carbapenem-resistant gram-negative bacteria on the outcome of patients with liver disease and cirrhosis.

Methods: Between January 2011 and July 2015, 132 patients treated at the tertiary liver transplant centre at University Hospital Frankfurt, Germany, were tested positive for carbapenem-resistant gram-negative bacteria and retrospectively analysed in this study. Risk factors for fatal outcome were evaluated using multivariate regression analysis. Competing-risk analysis was performed on patients tested positive for Enterobacteriaceae or non-fermenting species, for example, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia. Subgroup analysis of cirrhotic patients was performed on a matched cohort of cirrhotic patients, comparable model for end-stage liver disease and tested negative for carbapenem-resistant gram-negative bacteria.

Results: 97 (73.5%) and 35 (26.5%) patients were infected or colonised with carbapenem-resistant gram-negative bacteria respectively. Within the observation period, 61/132 (46.2%) patients died, with sepsis being the leading cause (38/61, 62.3%). Decompensated liver disease, sepsis and admission to intensive care unit were independent risk factors for fatal outcome. Lethal sepsis in patients positive for non-fermenting bacteria was significantly more frequent than in those positive for Enterobacteriaceae, independently from liver function. Subgroup analysis of cirrhotic patients showed that sepsis (54.9% vs 13%) and lethal sepsis were significantly more frequent after detection of carbapenem-resistant gram-negative bacteria, independently from localisation of pathogen detection.

Conclusions: Patients with advanced liver disease are prone to fatal infections caused by carbapenem-resistant gram-negative bacteria.

Keywords: carbapenem resistance; cirrhosis; liver disease; multidrug-resistant organisms; sepsis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carbapenems / therapeutic use
  • Chi-Square Distribution
  • Drug Resistance, Multiple, Bacterial*
  • Female
  • Germany
  • Gram-Negative Bacteria / drug effects*
  • Gram-Negative Bacteria / pathogenicity
  • Gram-Negative Bacterial Infections / diagnosis
  • Gram-Negative Bacterial Infections / drug therapy
  • Gram-Negative Bacterial Infections / microbiology*
  • Gram-Negative Bacterial Infections / mortality*
  • Hospitals, University
  • Humans
  • Kaplan-Meier Estimate
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / microbiology*
  • Liver Cirrhosis / mortality*
  • Liver Cirrhosis / surgery
  • Liver Transplantation / mortality
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Sepsis / diagnosis
  • Sepsis / drug therapy
  • Sepsis / microbiology*
  • Sepsis / mortality*
  • Time Factors
  • Treatment Outcome
  • Young Adult

Substances

  • Carbapenems