Terlipressin therapy is associated with increased risk of colonisation with multidrug-resistant bacteria in patients with decompensated cirrhosis.
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Mücke Marcus M, Hernández-Tejero María, Gu Wenyi, Kuhn Michael, Janz Malte, Keller Marisa I, Fullam Anthony, Altepeter Laura, Mücke Victoria T, Finkelmeier Fabian, Schwarzkopf Katharina M, Cremonese Carla, Hunyady Peter-Merton, Heilani Myriam W, Uschner Frank Erhard, Schierwagen Robert, Brol Maximilian J, Fischer Julia, Klein Sabine, Peiffer Kai-Henrik, Hogardt Michael, Shoaie Saeed, Coenraad Minneke J, Bojunga Jörg, Arroyo Vicente, Zeuzem Stefan, Kempf Volkhard A J, Welsch Christoph, Laleman Wim, Bork Peer, Fernandez Javier, Trebicka Jonel, MICROB-PREDICT and PREDICT Study Group of the EASL-CLIF Consortium
Аннотация
AIM: The aim of the study was to assess the influence of non-antibiotic medication contributing to MDRO colonisation.
METHODS: Three hundred twenty-four patients with AD and ACLF admitted to the ICU of Frankfurt University Hospital with MDRO screening were included. Regression models were performed to identify drugs associated with MDRO colonisation. Another cohort (n = 129) from Barcelona was included to validate. A third multi-centre cohort (n = 203) with metagenomic sequencing data of stool was included to detect antibiotic resistance genes.
RESULTS: A total of 97 patients (30%) were identified to have MDRO colonisation and 35 of them (11%) developed MDRO infection. Patients with MDRO colonisation had significantly higher risk of MDRO infection than those without (p = 0.0098). Apart from antibiotic therapy (odds ratio (OR) 2.91, 95%-confidence interval (CI) 1.82-4.93, p < 0.0001), terlipressin therapy in the previous 14 days was the only independent covariate associated with MDRO colonisation in both cohorts, the overall (OR 9.47, 95%-CI 2.96-30.23, p < 0.0001) and after propensity score matching (OR 5.30, 95%-CI 1.22-23.03, p = 0.011). In the second cohort, prior terlipressin therapy was a risk factor for MDRO colonisation (OR 2.49, 95% CI 0.911-6.823, p = 0.075) and associated with risk of MDRO infection during follow-up (p = 0.017). The validation cohort demonstrated that antibiotic inactivation genes were significantly associated with terlipressin administration (p = 0.001).
CONCLUSIONS: Our study reports an increased risk of MDRO colonisation in patients with AD or ACLF, who recently received terlipressin therapy, while other commonly prescribed non-antibiotic co-medications had negligible influence. Future prospective trials are needed to confirm these results.