The impact of multidrug-resistantMAQ:There is a mismatch in the article title given in the manuscript and title page of PDF. We have followed the manuscript. microorganisms on critically ill patients with cirrhosis in the intensive care unit: a cohort study
The impact of multidrug-resistant (MDR) colonization and MDR infection in critically ill cirrhosis patients remains unclear. We assessed the association of MDR colonization and MDR infection with these patients’ survival. Observational cohort study including adult cirrhosis patients admitted to 5 in...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health/LWW
2023-02-01
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| Series: | Hepatology Communications |
| Online Access: | http://journals.lww.com/10.1097/HC9.0000000000000038 |
| _version_ | 1811161612885688320 |
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| author | Minjee Kim Filipe S. Cardoso Anna Pawlowski Richard Wunderink Daniela P. Ladner Juan G. Abraldes Constantine J. Karvellas |
| author_facet | Minjee Kim Filipe S. Cardoso Anna Pawlowski Richard Wunderink Daniela P. Ladner Juan G. Abraldes Constantine J. Karvellas |
| author_sort | Minjee Kim |
| collection | DOAJ |
| description | The impact of multidrug-resistant (MDR) colonization and MDR infection in critically ill cirrhosis patients remains unclear. We assessed the association of MDR colonization and MDR infection with these patients’ survival. Observational cohort study including adult cirrhosis patients admitted to 5 intensive care units at Northwestern Memorial Hospital (Chicago, Illinois, USA) on January 1, 2010, to December 31, 2017. Patients admitted for elective liver transplant or with previous liver transplant were excluded. Patients were screened for MDR colonization on intensive care unit admission. Infection diagnoses during the intensive care unit stay were considered. The primary endpoint was hospital transplant-free survival. Among 600 patients included, 362 (60%) were men and median (interquartile range) age was 58.0 (49.0, 64.0) years. Median (interquartile range) Model for End-stage Liver Disease, Sequential Organ Failure Assessment, and Chronic Liver Failure—Acute-on-Chronic Liver Failure scores on intensive care unit day 1 were 28.0 (20.0, 36.0), 9.0 (6.0, 13.0), and 55.0 (48.0, 64.0), respectively. Overall, 76 (13%) patients were transplanted and 443 (74%) survived the hospital stay. Infections were diagnosed in 347 (58%) patients: pneumonia in 197 (33%), urinary tract infection in 119 (20%), peritonitis in 93 (16%), bloodstream infection in 99 (16%), Clostridium difficile colitis in 9 (2%), and catheter tip infection in 7 (1%). MDR colonization and MDR infection were identified in 200 (33%) and 69 (12%) patients, respectively. MDR colonization was associated with MDR infection (p < 0.001). MDR colonization or MDR infection was associated with higher number and duration of antibiotics (p < 0.001). Following adjustment for covariables (age, sex, etiology, portal hypertension, and Sequential Organ Failure Assessment score), MDR colonization [OR (95% CI), 0.64 (0.43, 0.95)] or MDR infection [adjusted OR (95% CI), 0.22 (0.12, 0.40)] were independently associated with lower transplant-free survival. Among critically ill cirrhosis patients, MDR colonization or MDR infection portended a worse prognosis. |
| first_indexed | 2024-04-10T06:17:12Z |
| format | Article |
| id | doaj.art-52e89fb53c5c41ad9d3ec85a79641974 |
| institution | Directory Open Access Journal |
| issn | 2471-254X |
| language | English |
| last_indexed | 2024-04-10T06:17:12Z |
| publishDate | 2023-02-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Hepatology Communications |
| spelling | doaj.art-52e89fb53c5c41ad9d3ec85a796419742023-03-02T06:30:44ZengWolters Kluwer Health/LWWHepatology Communications2471-254X2023-02-0172e0038e003810.1097/HC9.0000000000000038HC90000000000000038The impact of multidrug-resistantMAQ:There is a mismatch in the article title given in the manuscript and title page of PDF. We have followed the manuscript. microorganisms on critically ill patients with cirrhosis in the intensive care unit: a cohort studyMinjee Kim0Filipe S. Cardoso1Anna Pawlowski2Richard Wunderink3Daniela P. Ladner4Juan G. Abraldes5Constantine J. Karvellas6 1 Division of Neurocritical Care, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA 3 Transplant Unit and Intensive Care Unit, Curry Cabral Hospital, Nova Medical School, Lisbon, Portugal 5 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA 5 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA 2 Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA 4 Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada 4 Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, CanadaThe impact of multidrug-resistant (MDR) colonization and MDR infection in critically ill cirrhosis patients remains unclear. We assessed the association of MDR colonization and MDR infection with these patients’ survival. Observational cohort study including adult cirrhosis patients admitted to 5 intensive care units at Northwestern Memorial Hospital (Chicago, Illinois, USA) on January 1, 2010, to December 31, 2017. Patients admitted for elective liver transplant or with previous liver transplant were excluded. Patients were screened for MDR colonization on intensive care unit admission. Infection diagnoses during the intensive care unit stay were considered. The primary endpoint was hospital transplant-free survival. Among 600 patients included, 362 (60%) were men and median (interquartile range) age was 58.0 (49.0, 64.0) years. Median (interquartile range) Model for End-stage Liver Disease, Sequential Organ Failure Assessment, and Chronic Liver Failure—Acute-on-Chronic Liver Failure scores on intensive care unit day 1 were 28.0 (20.0, 36.0), 9.0 (6.0, 13.0), and 55.0 (48.0, 64.0), respectively. Overall, 76 (13%) patients were transplanted and 443 (74%) survived the hospital stay. Infections were diagnosed in 347 (58%) patients: pneumonia in 197 (33%), urinary tract infection in 119 (20%), peritonitis in 93 (16%), bloodstream infection in 99 (16%), Clostridium difficile colitis in 9 (2%), and catheter tip infection in 7 (1%). MDR colonization and MDR infection were identified in 200 (33%) and 69 (12%) patients, respectively. MDR colonization was associated with MDR infection (p < 0.001). MDR colonization or MDR infection was associated with higher number and duration of antibiotics (p < 0.001). Following adjustment for covariables (age, sex, etiology, portal hypertension, and Sequential Organ Failure Assessment score), MDR colonization [OR (95% CI), 0.64 (0.43, 0.95)] or MDR infection [adjusted OR (95% CI), 0.22 (0.12, 0.40)] were independently associated with lower transplant-free survival. Among critically ill cirrhosis patients, MDR colonization or MDR infection portended a worse prognosis.http://journals.lww.com/10.1097/HC9.0000000000000038 |
| spellingShingle | Minjee Kim Filipe S. Cardoso Anna Pawlowski Richard Wunderink Daniela P. Ladner Juan G. Abraldes Constantine J. Karvellas The impact of multidrug-resistantMAQ:There is a mismatch in the article title given in the manuscript and title page of PDF. We have followed the manuscript. microorganisms on critically ill patients with cirrhosis in the intensive care unit: a cohort study Hepatology Communications |
| title | The impact of multidrug-resistantMAQ:There is a mismatch in the article title given in the manuscript and title page of PDF. We have followed the manuscript. microorganisms on critically ill patients with cirrhosis in the intensive care unit: a cohort study |
| title_full | The impact of multidrug-resistantMAQ:There is a mismatch in the article title given in the manuscript and title page of PDF. We have followed the manuscript. microorganisms on critically ill patients with cirrhosis in the intensive care unit: a cohort study |
| title_fullStr | The impact of multidrug-resistantMAQ:There is a mismatch in the article title given in the manuscript and title page of PDF. We have followed the manuscript. microorganisms on critically ill patients with cirrhosis in the intensive care unit: a cohort study |
| title_full_unstemmed | The impact of multidrug-resistantMAQ:There is a mismatch in the article title given in the manuscript and title page of PDF. We have followed the manuscript. microorganisms on critically ill patients with cirrhosis in the intensive care unit: a cohort study |
| title_short | The impact of multidrug-resistantMAQ:There is a mismatch in the article title given in the manuscript and title page of PDF. We have followed the manuscript. microorganisms on critically ill patients with cirrhosis in the intensive care unit: a cohort study |
| title_sort | impact of multidrug resistantmaq there is a mismatch in the article title given in the manuscript and title page of pdf we have followed the manuscript microorganisms on critically ill patients with cirrhosis in the intensive care unit a cohort study |
| url | http://journals.lww.com/10.1097/HC9.0000000000000038 |
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