Extensively drug-resistant bacteria are an independent predictive factor of mortality in 130 patients with spontaneous bacterial peritonitis or spontaneous bacteremia

Table 1 Demographic characteristics of patients with bacterial infections classified according to the drug resistance of the organism

	Total	Non-DR	MDR	XDR	P vaule1	P vaule2
	n = 130	n = 90	n = 27	n = 13
Age (yr)	62 (55-73)	62 (54-63)	62.5 (54.7-73.2)	62 (59-79)	0.928	0.379
Gender (Males)	89 (68.5)	57 (63.3)	23 (85.2)	9 (69.2)	0.768	0.035
Etiology of liver cirrhosis
Alcoholic	54 (41.5)	35 (38.9)	13 (48.1)	6 (46.2)	0.476	0.718
Viral	47 (36.1)	32 (35.6)	10 (37)	5 (38.5)
Other	29 (22.3)	23 (25.6)	4 (14.8)	2 (15.4)
MELD	20 (15-25)	20 (15-25)	19.5 (16-23)	25 (18-36)	0.947	0.044
Hospitalization days over the preceding 6 mo	10 (5-19)	9 (4-16)	15 (6.75-28)	11 (7.5-22)	0.014	0.249
Nosocomial infections, n (%)	47 (36.1)	23 (25.5)	16 (59.2)	8 (61.5)	0.001	0.008
HCA infections, n (%)	75 (57.6)	48 (53.3)	18 (66.6)	9 (69.2)	0.220	0.281
HCA and/or nosocomial infections, n (%)	99 (76.1)	59 (65.5)	27 (100)	13 (100)	< 0.001	0.011

¹Comparison between MDR and non-DR;

²Comparison between XDR and Non-DR, values are expressed in median (interquartile range). HCA: Health care associated infections; MDR: Multi-drug resistant; XDR: Extensively drug resistant.

Table 2 Laboratory characteristics of patients with bacterial infections classified according to the drug resistance of the organism

	Total	Non-DR	MDR	XDR	P vaule1	P vaule2
	n = 130	n =90	n = 27	n = 13
Leucocyte count × 109/L	7.38 (4.6-11.3)	7.34 (4.85-11.27)	7.2 (4.18-11.73)	7.51 (4.39-11.61)	0.797	0.967
Neutrophil/leucocyte%	81 (71-88)	79 (70-87)	84 (72-88)	83 (76-90)	0.608	0.163
Total Bilirubin (mg/dL)	3.8 (1.9-8.7)	4.2 (1.9-9.2)	2.6 (1.6-6.1)	4.2 (1.7-19.7)	0.305	0.792
Creatinine (mg/dL)	1.1 (0.8-1.7)	1.1 (0.8-1.5)	1.2 (0.8-1.7)	2 (0.8-5.0)	0.269	0.093
INR	1.6 (1.4-2.1)	1.6 (1.3-2.2)	1,5 (1.4-1.9)	2 (1.3-2.2)	0.958	0.423
AST (IU/L)	53 (30-105)	55 (30-121)	45 (32-74)	23 (18-78)	0.423	0.057
C-reactive protein (mg/L)	59 (23-108)	52 (22-102)	68 (30-138)	101 (18-120)	0.318	0.302
Fibrinogen (mg/dL)	239 (134-496)	344 (130-516)	170 (156-273)	247 (119-460)	0.393	0.628

¹Comparison between MDR and Non-DR;

²Comparison between XDR and non-DR; values are expressed in median (interquartile range). MDR: Multi-drug resistant; XDR: Extensively drug resistant.

Table 3 Isolated bacteria and antibiotic susceptibility tests

Antibiotic	OX	AMC	MEM	CTX	FEP	TGC	VA	CT	CIP	SXT
Gram-positive bacteria (63)
Resistance	34/63	22/63	25/63	27/63	26/63	0/63	2/63	51/63	38/63	24/63
S. aureus (8)	0/8	5/8	8/8	8/8	8/8	0/8	0/8	8/8	2/8	0/8
Streptococcus spp. (23)	3/22	0/23	0/23	0/23	0/23	0/23	0/23	11/23	11/23	0/23
S. pneumonia (2)	2/2	0/2	0/2	0/2	0/2	0/2	0/2	2/2	2/2	0/2
E. faecalis (13)	12/13	0/13	0/8	2/13	1/13	0/13	0/13	13/13	6/13	7/13
E. faecium (15)	15/15	15/15	15/15	15/15	15/15	0/15	0/15	15/15	15/15	15/15
E. faecium VRE (2)	2/2	2/2	2/2	2/2	2/2	0/2	2/2	2/2	2/2	2/2
Gram-negative bacteria (65)
Resistance	65/65	34/65	15/65	28/65	20/65	9/65	65/65	1/65	24/65	33/65
E. coli (25)	25/25	3/25	0/25	1/25	0/25	0/25	25/25	0/25	5/25	5/25
ESBL-E. coli (7)	7/7	7/7	0/7	7/7	6/7	0/7	7/7	0/7	7/7	6/7
MBL-E. coli (1)	1/1	1/1	1/1	1/1	1/1	0/1	1/1	0/1	1/1	1/1
K. pneumonia (9)	9/9	1/9	0/9	0/9	0/9	0/9	9/9	0/9	1/9	7/9
KPC-K. pneumonia (5)	5/5	5/5	5/5	5/5	5/5	2/5	5/5	0/5	4/5	1/1
ESBL-K. pneumonia (1)	1/1	1/1	0/1	1/1	0/1	0/1	1/1	0/1	0/1	1/1
K. pneumonia KPC+, col-R (1)	1/1	1/1	1/1	1/1	1/1	1/1	1/1	1/1	1/1	1/1
P. aeruginosa (5)	5/5	5/5	2/5	5/5	3/5	5/5	5/5	0/5	2/5	5/5
S. marcescens (2)	2/2	2/2	0/2	0/2	0/2	0/2	2/2	0/2	0/2	0/2
S. maltophilia (3)	3/3	2/3	3/3	3/3	1/3	0/3	3/3	0/3	0/3	0/3
A. baumannii (2)	2/2	2/2	2/2	2/2	2/2	1/2	2/2	0/2	2/2	2/2
ESBL P. mirabilis- (1)	1/1	1/1	0/1	1/1	1/1	0/1	1/1	0/1	1/1	1/1
E. cloacae (2)	2/2	2/2	1/2	0/2	0/2	0/2	2/2	0/2	0/2	2/2
E. aerogenes (1)	1/1	1/1	0/1	1/1	0/1	0/1	1/1	0/1	0/1	1/1
Anaerobes (2)
Resistance	2/2	1/2	0/2	2/2	2/2	2/2	2/2	2/2	2/2	2/2
Bacteroides spp (2)	2/2	1/2	0/2	2/2	2/2	2/2	2/2	2/2	2/2	2/2

OX: Oxacillin; AMC: Amoxicillin/Clavulanic acid; MEM: Meropenem; CTX: Cefotaxime; FEP: Cefepime; TGC: Tigecycline; VA: Vancomycin; CT: Colistin; CIP: Ciprofloxacin; SXT: Cotrimoxazole; ESBL: Extended-spectrum-beta-lactamase-producing; KPC+, col-R: Carbapenemase-producing colistin-resistant K. pneumonia; MBL: Metallo-β-lactamase-producing; VRE: Vancomycin-resistant E. Faecium. S. aureus: Staphylococcus aureus; S. pneumonia: Streptococcus pneumoniae; E. faecalis: Enterococcus faecalis; E. faecium: Enterococcus faecium; E. coli: Escherichia coli; K. pneumonia: Klebsiella pneumonia; P. aeruginosa: Pseudomanas aeruginosa; S. marcescens: Serratia marcescens; S. maltophilia: Stenotrophomonas maltophilia; A. baumannii: Acinetobacter baumannii; P. mirabilis: Proteus mirabilis; E. cloacae: Enterobacter cloacae; E. aerogenes: Enterobacter aerogenes.

Table 4 Univariate and multivariate Cox regression analysis of factors predicting 30-d mortality in 130 patients with bacterial infections

	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Age (per 1 yr)	1.017 (0.997-1.037)	0.089
Gender	1.134 (0.833-1.542)	0.425
Neutrophil-to-	1.026 (0.998-1.055)	0.072
Leucocyte ratio
C-reactive protein	1.004 (0.999-1.008)	0.129
XDR infections	2.7 (1.310-5.565)	0.007	2.263 (1.005-5.095)	0.049
Total bilirubin	1.051 (1.020-1.082)	0.001
Creatinine	1.097 (1.006-1.197)	0.036	1.125 (1.024-1.236)	0.015
INR	1.746 (1.271-2.399)	0.001	1.553 (1.106-2.180)	0.011
AST	1.000 (0.999-1.001)	0.442

XDR: Extensively drug-resistant; INR: International normalized ratio.