1
|
Marciano S, Gutierrez-Acevedo MN, Barbero S, Del C Notari L, Agozino M, Fernandez JL, Anders MM, Grigera N, Antinucci F, Orozco Ganem OF, Murga MD, Perez D, Palazzo A, Martinez Rejtman L, Duarte IG, Vorobioff J, Trevizan V, Bulaty S, Bessone F, Valverde M, Elizondo M, Bosia JD, Borzi SM, Stieben TE, Masola A, Ferretti SE, Arufe D, Demirdjian E, Raffa MP, Peralta M, Fainboim HA, Vazquez CE, Ruiz P, Martínez JE, Heffner LA, Odzak A, Dirchwolf M, Smud A, Mendizabal M, Bellizzi C, Martinez A, Tomatis J, Bruno A, Ramos A, Pages J, Tevez S, Gadano AC, Giunta DH. Norfloxacin prophylaxis effect on multidrug resistance in patients with cirrhosis and bacterial infections. Eur J Clin Microbiol Infect Dis 2023; 42:481-491. [PMID: 36820931 DOI: 10.1007/s10096-023-04572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
It is unclear whether norfloxacin predisposes to infections by multidrug-resistant organisms (MDROs). We aimed to evaluate if patients with cirrhosis receiving norfloxacin prophylaxis at the time of the diagnosis of bacterial infections were more likely to present a multidrug-resistant isolate than those without prophylaxis. This is a cross-sectional study of hospitalized patients with cirrhosis and bacterial infections from Argentina and Uruguay (NCT03919032) from September 2018 to December 2020. The outcome variable was a multidrug-resistant bacterial infection. We used inverse probability of treatment weighting to estimate the odds ratio (OR) of norfloxacin on infection caused by MDROs considering potential confounders. Among the 472 patients from 28 centers, 53 (11%) were receiving norfloxacin at the time of the bacterial infection. Patients receiving norfloxacin had higher MELD-sodium, were more likely to have ascites or encephalopathy, to receive rifaximin, beta-blockers, and proton-pump inhibitors, to have a nosocomial or health-care-associated infection, prior bacterial infections, admissions to critical care units or invasive procedures, and to be admitted in a liver transplant center. In addition, we found that 13 (24.5%) patients with norfloxacin and 90 (21.5%) of those not receiving it presented infections caused by MDROs (adjusted OR 1.55; 95% CI: 0.60-4.03; p = 0.360). The use of norfloxacin prophylaxis at the time of the diagnosis of bacterial infections was not associated with multidrug resistance. These results help empiric antibiotic selection and reassure the current indication of norfloxacin prophylaxis in well-selected patients.Study registration number: NCT03919032.
Collapse
Affiliation(s)
- Sebastián Marciano
- Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
- Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | | | - Sabrina Barbero
- Liver Unit, Hospital Churruca Visca, Buenos Aires, Argentina
| | | | | | | | | | - Nadia Grigera
- Liver Unit, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Maria D Murga
- Liver Unit, Hospital A.C. Padilla, San Miguel de Tucumán, Argentina
| | - Daniela Perez
- Liver Unit, Hospital A.C. Padilla, San Miguel de Tucumán, Argentina
| | - Ana Palazzo
- Liver Unit, Hospital A.C. Padilla, San Miguel de Tucumán, Argentina
| | | | - Ivonne G Duarte
- P. R. Liver Unit, Hospital 4 de Junio, Sáenz Peña, Argentina
| | - Julio Vorobioff
- Liver Unit, Hospital Provincial del Centenario, Rosario, Argentina
| | | | - Sofía Bulaty
- Liver Unit, Hospital Provincial del Centenario, Rosario, Argentina
| | - Fernando Bessone
- Liver Unit, Hospital Provincial del Centenario, Rosario, Argentina
| | - Marcelo Valverde
- Liver Unit, Unidad Bi-Institucional de Trasplante Hepatico, Hospital de Clínicas - Hospital Militar, Montevideo, Uruguay
| | - Martín Elizondo
- Liver Unit, Unidad Bi-Institucional de Trasplante Hepatico, Hospital de Clínicas - Hospital Militar, Montevideo, Uruguay
| | | | | | | | | | | | - Diego Arufe
- Liver Unit, Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | | | - Maria P Raffa
- Liver Unit, Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | | | | | - Cintia E Vazquez
- Liver Unit, Regional Hospital of Rio Gallegos, Rio Gallegos, Argentina
| | - Pablo Ruiz
- Liver Unit, Regional Hospital of Rio Gallegos, Rio Gallegos, Argentina
| | | | | | - Andrea Odzak
- Liver Unit, Hospital Argerich, Buenos Aires, Argentina
| | | | - Astrid Smud
- Infectious Diseases Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Ana Martinez
- Liver Unit, Hospital Fernández, Buenos Aires, Argentina
| | - Jesica Tomatis
- Liver Unit, Hospital Privado de Rosario, Rosario, Argentina
| | - Andres Bruno
- Liver Unit, Hospital Argerich, Buenos Aires, Argentina
| | - Agñel Ramos
- Liver Unit, Sanatorio Parque, Rosario, Argentina
| | - Josefina Pages
- Liver Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Silvina Tevez
- Liver Unit, Sanatorio Güemes, Buenos Aires, Argentina
| | - Adrian C Gadano
- Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego H Giunta
- Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|