Influence of antibiotic-regimens on intensive-care unit-mortality and liver-cirrhosis as risk factor

AIM: To assess the rate of infection, appropriateness of antimicrobial-therapy and mortality on intensive care unit(ICU). Special focus was drawn on patients with liver cirrhosis.METHODS: The study was approved by the local ethical committee. All patients admitted to the Internal Medicine-ICU between April 1, 2007 and December 31, 2009 were included. Data were extracted retrospectively from all patients using patient charts and electronic documentations on infection, microbiological laboratory reports, diagnosis and therapy. Due to the large hepatology department and liver transplantation center, special interest was on the subgroup of patients with liver cirrhosis. The primary statistical-endpoint was the evaluation of the influence of appropriate versusinappropriate antimicrobial-therapy on in-hospitalmortality.RESULTS: Charts of 1979 patients were available. The overall infection-rate was 53%. Multiresistantbacteria were present in 23% of patients with infection and were associated with increased mortality(p < 0.000001). patients with infection had significantly increased in-hospital-mortality(34% vs 17%, p < 0.000001). Only 9% of patients with infection received inappropriate initial antimicrobial-therapy, no influence on mortality was observed. Independent risk-factors for in-hospital-mortality were the presence of septicshock, prior chemotherapy for malignoma and infection with pseudomonas spp. Infection and mortality-rate among 175 patients with liver-cirrhosis was significantly higher than in patients without liver-cirrhosis. Infection increased mortality 2.24-fold in patients with cirrhosis. patients with liver cirrhosis were at an increased risk to receive inappropriate initial antimicrobial therapy.CONCLUSION: The results of the present study report the successful implementation of early-goal-directed therapy. Liver cirrhosis patients are at increased risk of infection, mortality and to receive inappropriate therapy. Increasing burden are multiresistant-bacteria.

Severe infection with multidrug-resistant Salmonella choleraesuis in a young patient with primary sclerosing cholangitis

Massive global spread of multidrug-resistant(MDR) Salmonella spp. expressing extended-spectrum beta-lactamase(ESBL) and additional resistance to fluoroquinolones has often been attributed to high international mobility as well as excessive use of oral antibiotics in livestock farming. However, MDR Salmonella spp. have not been mentioned as a widespread pathogen in clinical settings so far. We demonstrate the case of a 25-year-old male with primary sclerosing cholangitis who tested positive for MDR Salmonella enterica serotype Choleraesuis expressing ESBL and fluoroquinolone resistance. The pathogen was supposedly acquired during a trip to Thailand, causing severe fever, cholangitis andpancreatitis. To our knowledge, this is the first report of Salmonella enterica serotype Choleraesuis in Europe expressing such a multidrug resistance pattern. ESBL resistance of Salmonella enterica spp. should be considered in patients with obstructive biliary tract pathology and travel history in endemic countries.