Epidemiology and risk factors for multi-drug resistant hospital-acquired urinary tract infection in patients with liver cirrhosis: single center experience in Serbia
Abstract Background Cirrhosis-associated immune dysfunction syndrome (CAIDS) has been identified in patients with liver cirrhosis (LC), predisposing them to a wide variety of infections. In patients with LC, healthcare-associated infections involving multi-drug resistant (MDR) bacteria have increase...
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | http://link.springer.com/article/10.1186/s12879-019-3761-5 |
| _version_ | 1818552574152802304 |
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| author | Tamara Milovanovic Igor Dumic Jelena Veličkovic Milica Stojkovic Lalosevic Vladimir Nikolic Ivan Palibrk |
| author_facet | Tamara Milovanovic Igor Dumic Jelena Veličkovic Milica Stojkovic Lalosevic Vladimir Nikolic Ivan Palibrk |
| author_sort | Tamara Milovanovic |
| collection | DOAJ |
| description | Abstract Background Cirrhosis-associated immune dysfunction syndrome (CAIDS) has been identified in patients with liver cirrhosis (LC), predisposing them to a wide variety of infections. In patients with LC, healthcare-associated infections involving multi-drug resistant (MDR) bacteria have increased significantly over the last decades. Among them, hospital-acquired urinary tract infections (HA-UTI) are the most common. This study aimed to investigate the rates of antimicrobial resistance among patients with LC and HA-UTI and to determine risk factors associated with their development among patients hospitalized in tertiary care facility in Serbia. Methods This retrospective study included 65 hospitalized patients with LC who had developed HA-UTI. We examined the epidemiology of these infections concerning resistance to the most commonly used antimicrobials and patient-specific risk factors associated with HA-UTI development by MDR pathogens. Results The most frequently isolated organisms were Enterococcus spp. (n = 34, 52.3%), Klebsiella spp. (n = 10, 15.4%), and E.coli (n = 6, 9.2%). Thirty-five isolates (53.8%) were identified as MDR, and 30 (46.2%) were non-MDR.We found a statistically significant difference in the distribution of MDR and non-MDR strains, based on Gram staining, with the majority of Gram-negative pathogens being MDR (p = 0.005). We identified age ≥ 65 years (p = 0.007), previous use of cephalosporins as empiric therapy (p = 0.042), and the presence of hepatic encephalopathy (p = 0.011) as independent risk factors for the development of MDR UTIs. Conclusion This is the first study from Serbia and the Balkans concerning the changing epidemiology of MDR UTI in patients with LC. Our study showed that more than half of HA-UTI was caused by MDR and the most common pathogen was Enterococcus spp. The overall resistance to ceftriaxone was 92%. Our findings underscore the need for institutions to individualize protocols for treatment of hospital-acquired infections, particularly in immunocompromised populations. |
| first_indexed | 2024-12-12T09:14:57Z |
| format | Article |
| id | doaj.art-f4cebe0895824aaf9613883e47bf9453 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-12T09:14:57Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-f4cebe0895824aaf9613883e47bf94532022-12-22T00:29:25ZengBMCBMC Infectious Diseases1471-23342019-02-0119111010.1186/s12879-019-3761-5Epidemiology and risk factors for multi-drug resistant hospital-acquired urinary tract infection in patients with liver cirrhosis: single center experience in SerbiaTamara Milovanovic0Igor Dumic1Jelena Veličkovic2Milica Stojkovic Lalosevic3Vladimir Nikolic4Ivan Palibrk5School of Medicine, University of BelgradeDepartment of Hospital Medicine, Mayo Clinic Health SystemSchool of Medicine, University of BelgradeSchool of Medicine, University of BelgradeSchool of Medicine, University of BelgradeDepartment of Anesthesiology, Clinical Center of SerbiaAbstract Background Cirrhosis-associated immune dysfunction syndrome (CAIDS) has been identified in patients with liver cirrhosis (LC), predisposing them to a wide variety of infections. In patients with LC, healthcare-associated infections involving multi-drug resistant (MDR) bacteria have increased significantly over the last decades. Among them, hospital-acquired urinary tract infections (HA-UTI) are the most common. This study aimed to investigate the rates of antimicrobial resistance among patients with LC and HA-UTI and to determine risk factors associated with their development among patients hospitalized in tertiary care facility in Serbia. Methods This retrospective study included 65 hospitalized patients with LC who had developed HA-UTI. We examined the epidemiology of these infections concerning resistance to the most commonly used antimicrobials and patient-specific risk factors associated with HA-UTI development by MDR pathogens. Results The most frequently isolated organisms were Enterococcus spp. (n = 34, 52.3%), Klebsiella spp. (n = 10, 15.4%), and E.coli (n = 6, 9.2%). Thirty-five isolates (53.8%) were identified as MDR, and 30 (46.2%) were non-MDR.We found a statistically significant difference in the distribution of MDR and non-MDR strains, based on Gram staining, with the majority of Gram-negative pathogens being MDR (p = 0.005). We identified age ≥ 65 years (p = 0.007), previous use of cephalosporins as empiric therapy (p = 0.042), and the presence of hepatic encephalopathy (p = 0.011) as independent risk factors for the development of MDR UTIs. Conclusion This is the first study from Serbia and the Balkans concerning the changing epidemiology of MDR UTI in patients with LC. Our study showed that more than half of HA-UTI was caused by MDR and the most common pathogen was Enterococcus spp. The overall resistance to ceftriaxone was 92%. Our findings underscore the need for institutions to individualize protocols for treatment of hospital-acquired infections, particularly in immunocompromised populations.http://link.springer.com/article/10.1186/s12879-019-3761-5Liver cirrhosisUrinary tract infectionMulti-drug resistant organismImmune dysfunction |
| spellingShingle | Tamara Milovanovic Igor Dumic Jelena Veličkovic Milica Stojkovic Lalosevic Vladimir Nikolic Ivan Palibrk Epidemiology and risk factors for multi-drug resistant hospital-acquired urinary tract infection in patients with liver cirrhosis: single center experience in Serbia BMC Infectious Diseases Liver cirrhosis Urinary tract infection Multi-drug resistant organism Immune dysfunction |
| title | Epidemiology and risk factors for multi-drug resistant hospital-acquired urinary tract infection in patients with liver cirrhosis: single center experience in Serbia |
| title_full | Epidemiology and risk factors for multi-drug resistant hospital-acquired urinary tract infection in patients with liver cirrhosis: single center experience in Serbia |
| title_fullStr | Epidemiology and risk factors for multi-drug resistant hospital-acquired urinary tract infection in patients with liver cirrhosis: single center experience in Serbia |
| title_full_unstemmed | Epidemiology and risk factors for multi-drug resistant hospital-acquired urinary tract infection in patients with liver cirrhosis: single center experience in Serbia |
| title_short | Epidemiology and risk factors for multi-drug resistant hospital-acquired urinary tract infection in patients with liver cirrhosis: single center experience in Serbia |
| title_sort | epidemiology and risk factors for multi drug resistant hospital acquired urinary tract infection in patients with liver cirrhosis single center experience in serbia |
| topic | Liver cirrhosis Urinary tract infection Multi-drug resistant organism Immune dysfunction |
| url | http://link.springer.com/article/10.1186/s12879-019-3761-5 |
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