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The threat of carbapenem resistance in Eastern Europe in patients with decompensated cirrhosis admitted to intensive care unit

  • Petra Fischer
    Affiliations
    Gastroenterology and Hepatology Department, University of Medicine and Pharmacy "Iuliu Hatieganu”, 19-21 Croitorilor Street, Cluj-Napoca 400162, Romania
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  • Stanca Pandrea
    Affiliations
    Microbiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
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  • Mircea Dan Grigorescu
    Affiliations
    Microbiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
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  • Horia Stefanescu
    Affiliations
    Gastroenterology and Hepatology Department, University of Medicine and Pharmacy "Iuliu Hatieganu”, 19-21 Croitorilor Street, Cluj-Napoca 400162, Romania

    Hepatology Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor" Cluj-Napoca, Romania
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  • Cristian Tefas
    Affiliations
    Gastroenterology and Hepatology Department, University of Medicine and Pharmacy "Iuliu Hatieganu”, 19-21 Croitorilor Street, Cluj-Napoca 400162, Romania

    Hepatology Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor" Cluj-Napoca, Romania
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  • Adina Hadade
    Affiliations
    Department of Anesthesia and Intensive Care I, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania

    Anesthesia and Intensive Care Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor”, Cluj-Napoca, Romania
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  • Bogdan Procopet
    Correspondence
    Corresponding author.
    Affiliations
    Gastroenterology and Hepatology Department, University of Medicine and Pharmacy "Iuliu Hatieganu”, 19-21 Croitorilor Street, Cluj-Napoca 400162, Romania

    Hepatology Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor" Cluj-Napoca, Romania
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  • Daniela Ionescu
    Affiliations
    Department of Anesthesia and Intensive Care I, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania

    Anesthesia and Intensive Care Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor”, Cluj-Napoca, Romania

    Outcome Research Consortium Department Cleveland, United States
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      Abstract

      Background

      Multidrug-resistant organisms are an increasing concern in patients with decompensated cirrhosis.

      Aim

      We aimed to evaluate the prevalence of infections with carbapenem-resistant Enterobacteriaceae in patients with decompensated cirrhosis.

      Methods

      Patients with decompensated cirrhosis admitted to ICU were included. The isolated Enterobacteriaceae strains were tested for carbapenemase-producing genes using the Roche LightMix® Modular VIM/IMP/NDM/GES/KPC/OXA48-carbapenemase detection kit.

      Results

      48 culture-positive infections were registered in 75 patients with acutely decompensated cirrhosis. Thirty patients contracted a second infection. 46% of bacteria isolated at admission and 60% of bacteria responsible for infections identified during ICU-stay were multiresistant. ESBL+ Enterobacteriaceae were predominant at admission, while carbapenem-resistance was dominant in both Enterobacteriaceae and Non-Fermenting-Gram-Negative Bacteria responsible for infections diagnosed during hospitalisation. OXA 48 or KPC type carbapenemases were present in 30% of the analyzed Enterobacteriaceae and in 40% of the phenotypically carbapenem-resistant Klebsiella pneumoniae strains. The length of ICU stay was a risk-factor for a second infection (p=0.04). Previous carbapenem usage was associated with occurence of infections with carbapenem-resistant Gram-negative bacteria during hospitalization (p=0.03).

      Conclusion

      The prevalence of infections with carbapenem-resistant Enterobacteriaceae is high in patients with decompensated cirrhosis admitted to ICU. Carbapenemase-producing genes in Enterobacteriaceae in our center are bla OXA-48 and bla KPC.

      Keywords

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