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An empirical broad spectrum antibiotic therapy in Healthcare-Associated infections improves survival in cirrhotics: A randomized trial.
Hepatology. 2015 Nov 3;
Authors: Merli M, Lucidi C, Di Gregorio V, Lattanzi B, Giannelli V, Giusto M, Farcomeni A, Ceccarelli G, Falcone M, Riggio O, Venditti M
Abstract
Early diagnosis and appropriate treatment of infections in cirrhosis are crucial due to their high morbidity and mortality. Multidrug-resistant (MDR) infections are on the increase in healthcare settings. Healthcare-associated (HCA) infections are still frequently treated as community-acquired with a detrimental effect on survival. We aimed to prospectively evaluate in a randomized trial the effectiveness of a Broad Spectrum antibiotic treatment in cirrhotic patients with HCA infections. Consecutive cirrhotic patients hospitalized with HCA infections were enrolled. After culture sampling, patients were promptly randomized to receive a Standard or a Broad Spectrum antibiotic treatment (NCT01820026). The primary endpoint was in-hospital mortality. Efficacy, side effects and the length of hospitalization were considered. Treatment failure was followed by a change in antibiotic therapy. Ninety-six patients were randomized and 94 were included. The two groups were similar for demographic, clinical and microbiological characteristics. The prevalence of MDR pathogens was 40% in the Standard vs 46% in the Broad Spectrum group. In-hospital mortality showed a substantial reduction in the Broad Spectrum vs Standard group (6 vs 25%, p=0.01). In a post-hoc analysis the reduction of mortality was more evident in patients with sepsis. The Broad Spectrum showed a lower rate of treatment failure than the Standard therapy (18 vs 51%, p=0.001). The length of hospitalization was shorter in the Broad Spectrum (12.3 ± 7 days) vs Standard group (18 ± 15 days) (p= 0.03). Five patients in each group developed a second infection during hospitalization with a similar prevalence of MDR (50% Broad Spectrum vs 60% Standard).
CONCLUSIONS: A Broad Spectrum antibiotic therapy as empirical treatment in HCA infections improves survival in cirrhosis. This treatment was significantly effective, safe and cost-saving. This article is protected by copyright. All rights reserved.
PMID: 26529126 [PubMed - as supplied by publisher]