The Korean journal of internal medicine

  • 제39권3호
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  • Pages.448-457
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  • 2024
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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Prevalence and predictors of multidrug-resistant bacteremia in liver cirrhosis

  • Aryoung Kim (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Byeong Geun Song (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Wonseok Kang (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Dong Hyun Sinn (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Geum-Youn Gwak (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yong-Han Paik (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Moon Seok Choi (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Joon Hyeok Lee (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Myung Ji Goh (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2023.08.23
  • 심사 : 2024.01.02
  • 발행 : 2024.05.01
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초록

Background/Aims: Improved knowledge of local epidemiology and predicting risk factors of multidrug-resistant (MDR) bacteria are required to optimize the management of infections. This study examined local epidemiology and antibiotic resistance patterns of liver cirrhosis (LC) patients and evaluated the predictors of MDR bacteremia in Korea. Methods: This was a retrospective study including 140 LC patients diagnosed with bacteremia between January 2017 and December 2022. Local epidemiology and antibiotic resistance patterns and the determinants of MDR bacteremia were analyzed using logistic regression analysis. Results: The most frequently isolated bacteria, from the bloodstream, were Escherichia coli (n = 45, 31.7%) and Klebsiella spp. (n = 35, 24.6%). Thirty-four isolates (23.9%) were MDR, and extended-spectrum beta-lactamase E. coli (52.9%) and methicillin-resistant Staphylococcus aureus (17.6%) were the most commonly isolated MDR bacteria. When Enterococcus spp. were cultured, the majority were MDR (MDR 83.3% vs. 16.7%, p = 0.003), particularly vancomycin-susceptible Enterococcus faecium. Antibiotics administration within 30 days and/or nosocomial infection was a significant predictor of MDR bacteremia (OR: 3.40, 95% CI: 1.24-9.27, p = 0.02). MDR bacteremia was not predicted by sepsis predictors, such as positive systemic inflammatory response syndrome (SIRS) or quick Sequential Organ Failure Assessment (qSOFA). Conclusions: More than 70% of strains that can be treated with a third-generation cephalosporin have been cultured. In cirrhotic patients, antibiotic administration within 30 days and/or nosocomial infection are predictors of MDR bacteremia; therefore, empirical administration of broad-spectrum antibiotics should be considered when these risk factors are present.

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참고문헌

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