Multi-Drug Resistant Colonization or Infection Linked to Worse Prognosis for Critically Ill Cirrhosis Patients

Minjee Kim, MD

Multi-drug resistant (MDR) colonization and infections cause worse outcomes for critically ill patients with cirrhosis.

A team, led by Minjee Kim, Division of Neurocritical Care, Department of Neurology, Northwestern University Feinberg School of Medicine, assessed the association of MDR colonization and infection in critically ill patients with cirrhosis with overall survival.

Despite a recent focus, the impact of multidrug-resistant colonization and infection in critically ill patients with cirrhosis is largely unclear.

In the observational cohort study, the investigators examined adult patients with cirrhosis who were admitted to 5 intensive care units at Northwestern Memorial Hospital in Chicago between 2010-2017.

The team excluded patients admitted with elective liver transplants or those with previous liver transplants.

Each participant was screened for MDR colonization on admission to the intensive care unit, while the team considered infection diagnoses during the intensive care unit stay.

The investigators sought primary endpoints of hospital transplant-free survival.

There were a total of 600 patients included, 60% (n = 362) of which were male. The median age of the patient population was 58 years and the median Model for End-Stage Liver Disease, Sequential Organ Failure Assessment, and Chronic Liver Failure-Acute-on-Chronic Liver Failure scores on day 1 from the intensive care unit were 28.0 (20.0, 36.0), 9.0 (6.0, 13.0), and 55.0 (48.0, 64.0), respectively.

The results show 13% (n = 76) of patients were transplanted, while 74% (n = 443) survived the hospital stay. In addition, 58% (n = 347) of the patient population was diagnosed with an infection. Of this group, 33% (n = 197) were diagnosed with pneumonia, 20% (n = 119) were diagnosed with urinary tract infections, 16% (n = 93) were diagnosed with peritonitis, 16% (n = 99) were diagnosed with bloodstream infections, 2% (n = 9) were diagnosed with Clostridium difficile infections, and 1% (n = 7) were diagnosed with catheter tip infections.

MDR colonization and infection were found in 33% (n = 200) and 12% (n = 69) patients, respectively.

However, the results show MDR colonization was associated with MDR infection (P <0.001) and colonization and infection was linked to higher numbers and duration of antibiotics (P <0.001).

The investigators then adjusted for various covariables, including age, sex, etiology, portal hypertension, and Sequential Organ Failure Assessment score), and found MDR colonization (OR, 0.64; 95% CI, 0.43-0.95) or MDR infection (aOR, 0.22; 95% CI, 0.12-0.40) were independently linked to lower transplant-free survival.

“Among critically ill cirrhosis patients, MDR colonization or MDR infection portended a worse prognosis,” the authors wrote.

The study, “The impact of multidrug-resistant microorganisms on critically ill patients with cirrhosis in the intensive care unit: a cohort study,” was published online in Hepatology Communications.