Z Gastroenterol 2016; 54 - KV268
DOI: 10.1055/s-0036-1587044

Colonization and infection with carbapenem-resistant non-fermenting gram-negative bacteria are associated with rapid deterioration and mortality in patients with decompensated liver disease

PG Ferstl 1, N Filmann 2, C Brandt 3, S Zeuzem 1, TA Wichelhaus 3, M Hogardt 3, VA Kempf 3, O Waidmann 1, C Reinheimer 3
  • 1Klinikum der Goethe-Universität Frankfurt a.M., Medizinische Klinik 1, Frankfurt, Deutschland
  • 2Klinikum der Goethe-Universität Frankfurt a.M, Institut für Biostatistik und mathematische Modellierung, Frankfurt, Deutschland
  • 3Klinikum der Goethe-Universität Frankfurt a.M., Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Frankfurt, Deutschland

Background: Bacterial infections are frequent complications in patients with advanced liver disease and impair their prognosis. The number of infections with multi-drug resistant gram-negative bacteria (MRGN) is rapidly increasing. Especially the occurrence of carbapenem resistant gram-negative bacteria (CRGN) narrows the therapeutic options. This study investigated the impact of CRGN on the outcome of patients with liver diseases, and aimed to identify pathogens causing adverse courses in these patients.

Methods: We identified n = 132 liver patients in whom, whilst being treated at a tertiary liver transplant center in Deutschland between January 2011 and July 2015, colonization or infection with a CRGN strain was detected. Electronic patient files were retrospectively analyzed, patients were stratifed by clinical features and independent 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, e.g. Pseudomonas aeruginosa, Acinetobacter baumannii or Stenotrophomonas maltophilia.

Results: Infections with CRGN were found in 74.2% of patients, as opposed to colonization in 25.8%. Within the observational period, 45.5% of the individuals died. Sepsis was reported in 51.5% and was the leading cause for fatal outcome. Decompensated liver disease, sepsis and admission to intensive care unit (ICU) were independent risk factors for fatal outcome. Lethal sepsis due to P. aeruginosa, S. maltophilia and A. baumannii was significantly more frequent than due to Enterobacteriaceae, independently from liver function.

Conclusions: Patients with advanced liver disease are prone to fatal infections caused by CRGN, which might be enhanced by immune dysfunction. Since approaches sufficiently targeting CRGN are still lacking, colonization in these patients should urgently be prevented by concise hospital hygiene measures and reasonable administration of antibiotic drugs.

Key words: liver disease, cirrhosis, multidrug-resistant organisms, CRGN, carbapenemase, sepsis, immune dysfunction, fatal outcome.