Burden, risk factors, and outcomes of multidrug-resistant bacterial colonisation at multiple sites in patients with cirrhosis

Abstract

•Multi-drug resistant organism (MDRO) colonization at multiple sites at admission and day-7 was assessed in patients with cirrhosis•80% of patients were colonized with MDROs (20% with pan-drug resistant bacteria).•Rectum was the commonest site of colonization, followed by nose, skin and central line•Multiple precipitants of acute decompensation, norfloxacin prophylaxis, infection by multiple drug resistant bacteria independently predisposed to colonization by MDROs.•MDRO colonization; especially at multiple sites increased risk of infections by multiple drug resistant bacteria, multi-organ failures, mortality in cirrhosis•Local epidemiology of MDROs in surveillance cultures can guide antimicrobial stewardship decisions in cirrhosis patients. BackgroundBurden of multi-drug resistant organism (MDRO) infections is reported highest in patients with cirrhosis from India. We evaluated whether colonization at multiple barriers predisposes to such infections and poor outcomes in cirrhosis.MethodsWe prospectively performed swab cultures, antimicrobial susceptibility (AST), and genotype testing for MDROs from rectum, nose, composite-skin, and central-line in patients with cirrhosis (2020-2021) on admission and follow-up at a tertiary institute. We analyzed clinical data, risk factors for MDROs, and outcomes of patients.ResultsOf 125 patients aged 49 years, 85.6% males, 60.8% ACLF, 99 (79.2%) were identified as colonizers. MDRO-colonization at rectum, nose, skin, and central line was observed in 72.7% (88/121), 30.0% (36/120), 14.9% (18/121), and 3.3% (4/121) patients, respectively. Patients were colonized with ESBL (71/125), CRE (67/125), MDR-Enterococcus (48/125), MDR-Acinetobacter (21/125), or MRSA (4/125).Multiple precipitants of acute-decompensation (OR:3.4, p=0.042), norfloxacin prophylaxis (OR:3.9, p=0.008), and MDRO infection at admission (OR:8.9, p=0.041) were the independent predictors of colonization.Colonization increased the risk of infection by MDROs at admission (OR: 8.5, p=0.017) and follow-up (OR: 7.5, p<0.001). While any-site colonizers were at greater risk of cerebral failure and poorer Child-Pugh scores, the nasal and skin colonizers were at higher risk of cerebral and circulatory failures than non-colonizers (p<0.05).Patients with >1site colonization (prevalence:30%) developed multi-organ failures (p<0.05), MDRO infection (OR:7.9, p<0.001), and poorer 30-day survival (HR:2.0, p=0.005).ConclusionsA strikingly high burden of MDRO colonization among Indian cirrhotics necessitates urgent control measures. Multiple site colonization increases the risk of MDR-infections, multi-organ failures, and mortality in cirrhosis. Burden of multi-drug resistant organism (MDRO) infections is reported highest in patients with cirrhosis from India. We evaluated whether colonization at multiple barriers predisposes to such infections and poor outcomes in cirrhosis. We prospectively performed swab cultures, antimicrobial susceptibility (AST), and genotype testing for MDROs from rectum, nose, composite-skin, and central-line in patients with cirrhosis (2020-2021) on admission and follow-up at a tertiary institute. We analyzed clinical data, risk factors for MDROs, and outcomes of patients. Of 125 patients aged 49 years, 85.6% males, 60.8% ACLF, 99 (79.2%) were identified as colonizers. MDRO-colonization at rectum, nose, skin, and central line was observed in 72.7% (88/121), 30.0% (36/120), 14.9% (18/121), and 3.3% (4/121) patients, respectively. Patients were colonized with ESBL (71/125), CRE (67/125), MDR-Enterococcus (48/125), MDR-Acinetobacter (21/125), or MRSA (4/125). Multiple precipitants of acute-decompensation (OR:3.4, p=0.042), norfloxacin prophylaxis (OR:3.9, p=0.008), and MDRO infection at admission (OR:8.9, p=0.041) were the independent predictors of colonization. Colonization increased the risk of infection by MDROs at admission (OR: 8.5, p=0.017) and follow-up (OR: 7.5, p<0.001). While any-site colonizers were at greater risk of cerebral failure and poorer Child-Pugh scores, the nasal and skin colonizers were at higher risk of cerebral and circulatory failures than non-colonizers (p<0.05). Patients with >1site colonization (prevalence:30%) developed multi-organ failures (p<0.05), MDRO infection (OR:7.9, p<0.001), and poorer 30-day survival (HR:2.0, p=0.005). A strikingly high burden of MDRO colonization among Indian cirrhotics necessitates urgent control measures. Multiple site colonization increases the risk of MDR-infections, multi-organ failures, and mortality in cirrhosis.

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