Long-term Use of Antibiotics and Proton Pump Inhibitors Predict Development of Infections in Patients With Cirrhosis

Jacqueline G. O'Leary, K. Rajender Reddy, Florence Wong, Patrick Sequeira Kamath, Heather M. Patton, Scott W. Biggins, Michael B. Fallon, Guadalupe Garcia-Tsao, Ram M. Subramanian, Raza Malik, Leroy R. Thacker, Jasmohan S. Bajaj

Research output: Contribution to journalArticle

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Abstract

Background and Aims: Bacterial infections, particularly repeated infections, are significant causes of morbidity and mortality among patients with cirrhosis. We investigated and characterized risk factors for repeat infections in these patients. Methods: In a prospective study, we collected data from 188 patients hospitalized with cirrhosis and infections and enrolled in the North American Consortium for the Study of End-Stage Liver Disease (12 centers). Patients were followed up for 6 months after hospital discharge and data were analyzed on type of infections and factors associated with subsequent infections. Results: Six months after hospital discharge, 14% of subjects had received liver transplants, 27% died, and 59% were alive without liver transplantation. After discharge, 45% had subsequent infections, but only 26% of the subsequent infections occurred at the same site. Compared with patients not re-infected, patients with repeat infections were older and a higher proportion used proton pump inhibitors (PPIs) (P= .006), rifaximin (P < .001), or prophylactic therapy for spontaneous bacterial peritonitis (SBP) (P < .001). Logistic regression showed that SBP prophylaxis (odds ratio [OR], 3.44; 95% confidence interval [CI], 1.56-7.63), PPI use (OR, 2.94; 95% CI, 1.39-6.20), SBP at hospital admission (OR, 0.37; 95% CI, 0.15-0.91), and age (OR, 1.06; 95% CI, 1.02-1.11) were independent predictors of subsequent infections. Conclusions: Patients hospitalized with cirrhosis and infections are at high risk for subsequent infections, mostly at different sites, within 6 months of index infection resolution. Those at highest risk include previously infected older patients receiving PPIs and/or SBP prophylaxis, although these associations do not prove that these factors cause the infections. New strategies are needed to prevent infections in patients with cirrhosis.

Original languageEnglish (US)
Pages (from-to)753-759
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume13
Issue number4
DOIs
StatePublished - Apr 1 2015

Fingerprint

Proton Pump Inhibitors
Fibrosis
Anti-Bacterial Agents
Infection
Peritonitis
Odds Ratio
Confidence Intervals
rifaximin
End Stage Liver Disease
Bacterial Infections
Liver Transplantation

Keywords

  • Antibiotic
  • CARS
  • CI
  • Complication
  • CTP
  • Decompensation
  • DRO
  • MELD
  • NACSELD
  • NACSELD
  • OR
  • PPI
  • SBP
  • SIBO
  • UTI

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Long-term Use of Antibiotics and Proton Pump Inhibitors Predict Development of Infections in Patients With Cirrhosis. / O'Leary, Jacqueline G.; Reddy, K. Rajender; Wong, Florence; Kamath, Patrick Sequeira; Patton, Heather M.; Biggins, Scott W.; Fallon, Michael B.; Garcia-Tsao, Guadalupe; Subramanian, Ram M.; Malik, Raza; Thacker, Leroy R.; Bajaj, Jasmohan S.

In: Clinical Gastroenterology and Hepatology, Vol. 13, No. 4, 01.04.2015, p. 753-759.

Research output: Contribution to journalArticle

O'Leary, JG, Reddy, KR, Wong, F, Kamath, PS, Patton, HM, Biggins, SW, Fallon, MB, Garcia-Tsao, G, Subramanian, RM, Malik, R, Thacker, LR & Bajaj, JS 2015, 'Long-term Use of Antibiotics and Proton Pump Inhibitors Predict Development of Infections in Patients With Cirrhosis', Clinical Gastroenterology and Hepatology, vol. 13, no. 4, pp. 753-759. https://doi.org/10.1016/j.cgh.2014.07.060
O'Leary, Jacqueline G. ; Reddy, K. Rajender ; Wong, Florence ; Kamath, Patrick Sequeira ; Patton, Heather M. ; Biggins, Scott W. ; Fallon, Michael B. ; Garcia-Tsao, Guadalupe ; Subramanian, Ram M. ; Malik, Raza ; Thacker, Leroy R. ; Bajaj, Jasmohan S. / Long-term Use of Antibiotics and Proton Pump Inhibitors Predict Development of Infections in Patients With Cirrhosis. In: Clinical Gastroenterology and Hepatology. 2015 ; Vol. 13, No. 4. pp. 753-759.
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AU - O'Leary, Jacqueline G.

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AU - Wong, Florence

AU - Kamath, Patrick Sequeira

AU - Patton, Heather M.

AU - Biggins, Scott W.

AU - Fallon, Michael B.

AU - Garcia-Tsao, Guadalupe

AU - Subramanian, Ram M.

AU - Malik, Raza

AU - Thacker, Leroy R.

AU - Bajaj, Jasmohan S.

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N2 - Background and Aims: Bacterial infections, particularly repeated infections, are significant causes of morbidity and mortality among patients with cirrhosis. We investigated and characterized risk factors for repeat infections in these patients. Methods: In a prospective study, we collected data from 188 patients hospitalized with cirrhosis and infections and enrolled in the North American Consortium for the Study of End-Stage Liver Disease (12 centers). Patients were followed up for 6 months after hospital discharge and data were analyzed on type of infections and factors associated with subsequent infections. Results: Six months after hospital discharge, 14% of subjects had received liver transplants, 27% died, and 59% were alive without liver transplantation. After discharge, 45% had subsequent infections, but only 26% of the subsequent infections occurred at the same site. Compared with patients not re-infected, patients with repeat infections were older and a higher proportion used proton pump inhibitors (PPIs) (P= .006), rifaximin (P < .001), or prophylactic therapy for spontaneous bacterial peritonitis (SBP) (P < .001). Logistic regression showed that SBP prophylaxis (odds ratio [OR], 3.44; 95% confidence interval [CI], 1.56-7.63), PPI use (OR, 2.94; 95% CI, 1.39-6.20), SBP at hospital admission (OR, 0.37; 95% CI, 0.15-0.91), and age (OR, 1.06; 95% CI, 1.02-1.11) were independent predictors of subsequent infections. Conclusions: Patients hospitalized with cirrhosis and infections are at high risk for subsequent infections, mostly at different sites, within 6 months of index infection resolution. Those at highest risk include previously infected older patients receiving PPIs and/or SBP prophylaxis, although these associations do not prove that these factors cause the infections. New strategies are needed to prevent infections in patients with cirrhosis.

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KW - OR

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