February 02, 2022 Rectal colonization by multidrug-resistant bacteria increases the short-term risk of infection in patients with cirrhosis requiring critical care Collaborative research between EF Clif, Hospital Clínic de Barcelona and Goethe University Frankfurt shows higher risk of infections by the rectal colonizing resistant bacteria in critically ill cirrhotic patients

BARCELONA—Currently, antibiotic resistance represents a major concern for patients with cirrhosis. Previous work suggested that colonization by multidrug-resistant bacteria increases the risk of resistant infections in non-cirrhotic patients. New research in two geographically distinct cohorts in Europe by a team at the European Foundation for the Study of Chronic Liver Failure (EF Clif), Hospital Clinic de Barcelona and Goethe University Frankfurt shows that rectal colonization by antibiotic-resistant bacteria is a frequent and clinically relevant problem in patients with cirrhosis requiring critical care. The type of colonizing bacteria was found to be heterogeneous between centers. This study provides evidence that rectal colonization by antibiotic-resistant bacteria is associated with high risk of infections by the colonizing strain in cirrhotic patients admitted to the intensive care unit. Therefore, early detection of resistant carriers opens up the possibility for targeted antibiotic therapies and rapid isolation strategies. These measures in combination may contribute to reduce the spread of antibiotic resistance among hospitalized patients with cirrhosis. This work was published on 22 January 2022 in Journal of Hepatology.

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From left: Javier Fernandez, MD, PhD and Jonel Trebicka, MD, PhD

Credit: Hospital Clínic de Barcelona (left), Goethe University Frankfurt (right)

Researchers at EF Clif, Hospital Clínic de Barcelona and Goethe University Frankfurt conducted this study on a total of 907 patients, of which 550 were cirrhotic, admitted to the intensive care units at the Hospital Clínic de Barcelona, Spain, and University Clinic Frankfurt, Germany. Rectal colonization by antibiotic-resistant strains was common in both cohorts (42.6% in Barcelona and 47% in Frankfurt). Extended-spectrum beta-lactamase- Enterobacterales were the most predominant multidrug-resistant bacteria isolated in rectal swabs in the group of 129 patients from Spain, whereas vancomycin-resistant enterococci were found to be the predominant colonizing strain in the 421 patients in Germany. Multidrug-resistant bacteria carriers showed higher risk of developing severe bacterial infections at short-term. “This is, by far, the largest epidemiological surveillance investigation ever performed in cirrhosis”, said Javier Fernandez, clinical researcher at EF Clif and Head of the Liver Intensive Care Unit at Hospital Clínic de Barcelona, Spain. “We believe that epidemiological surveillance (periodic rectal swabs) constitutes a key measure for early identification of antibiotic-resistant bacteria carriers and helps to delineate empirical antibiotic strategies and de-escalation policies in decompensated cirrhosis”.

This study was supported by the Institute of Health Carlos III (ISCIII), PI16/00885.

Other authors on the study are Verónica Prado (MD), María Hernández-Tejero (MD), Marcus Mücke, Francesc Marco (MD, PhD), Wenyi Gu (MD), Alex Amoros, David Toapanta (MD), Enric Reverter (MD, PhD), Carlos de la Peña-Ramirez, Laura Altenpeter (MD), Octavi Bassegoda (MD), Gabriel Mezzano (MD), Fátima Aziz, Adria Juanola (MD), Sergio Rodriguez-Tajes (MD, PhD), Vanessa Chamorro, David López, Marta Reyes, Michael Hogardt, Volkhard A.J. Kempf, Philip Ferstl, Stefan Zeuzem, José Antonio Martínez (MD, PhD), Jordi Vila (MD, PhD), Vicente Arroyo (MD, PhD), and Jonel Trebicka (MD, PHD).

Publication information

Prado, V., Hernández-Tejero, M., Mücke, M. M., Marco, F., Gu, W., Amoros, A., Toapanta, D., Reverter, E., de la Peña-Ramirez, C., Altenpeter, L., Bassegoda, O., Mezzano, G., Aziz, F., Juanola, A., Rodríguez-Tajes, S., Chamorro, V., López, D., Reyes, M., Hogardt, M., Kempf, V. A. J., Ferstl, P. G., Zeuzem, S., Martínez, J. A., Vila, J., Arroyo, V., Trebicka, J., Fernandez, J. Rectal colonization by resistant bacteria increases the risk of infection by the colonizing strain in critically ill patients with cirrhosis. J. Hepatol. 2022. DOI: 10.1016/j.jhep.2021.12.042

The European Foundation for the Study of Chronic Liver Failure (EF Clif) is a private nonprofit organization which mission is to promote research and education in hepatic chronic failure with the aim to contribute to improving the quality of life and to increase the survival of patients with liver cirrhosis. Since its foundation in 2009, the European Association for the Study of the Liver (EASL) Chair supports research activities through the EASL-Clif Consortium, a network of more than 100 European university hospitals and more than 300 clinical researchers. The Grifols Chair promotes translational studies across centers throughout Europe and North America within the framework of the European Network for Translational Research (ENTR) with 25 centers and more than 40 investigators.