Clinical and microbiological features of infection in alcoholic hepatitis: an international cohort study

Research output: Contribution to journalArticlepeer-review

Standard

Clinical and microbiological features of infection in alcoholic hepatitis: an international cohort study. / Parker, Richard; Im, Gene; Jones, Fiona; Hernández, Onan Pérez; Nahas, Jonathan; Kumar, Aditi; Wheatley, Daniel; Sinha, Ashish; Gonzalez-reimers, Emilio; Sanchez-pérez, María; Ghezzi, Antonella; David, Miruna Delia; Corbett, Christopher; Mccune, Anne; Aithal, Guruprasad Padur; Holt, Andrew; Stewart, Stephen.

In: Journal of Gastroenterology, Vol. 52, No. 11, 11.2017, p. 1192–1200.

Research output: Contribution to journalArticlepeer-review

Harvard

Parker, R, Im, G, Jones, F, Hernández, OP, Nahas, J, Kumar, A, Wheatley, D, Sinha, A, Gonzalez-reimers, E, Sanchez-pérez, M, Ghezzi, A, David, MD, Corbett, C, Mccune, A, Aithal, GP, Holt, A & Stewart, S 2017, 'Clinical and microbiological features of infection in alcoholic hepatitis: an international cohort study', Journal of Gastroenterology, vol. 52, no. 11, pp. 1192–1200. https://doi.org/10.1007/s00535-017-1336-z

APA

Parker, R., Im, G., Jones, F., Hernández, O. P., Nahas, J., Kumar, A., Wheatley, D., Sinha, A., Gonzalez-reimers, E., Sanchez-pérez, M., Ghezzi, A., David, M. D., Corbett, C., Mccune, A., Aithal, G. P., Holt, A., & Stewart, S. (2017). Clinical and microbiological features of infection in alcoholic hepatitis: an international cohort study. Journal of Gastroenterology, 52(11), 1192–1200. https://doi.org/10.1007/s00535-017-1336-z

Vancouver

Author

Parker, Richard ; Im, Gene ; Jones, Fiona ; Hernández, Onan Pérez ; Nahas, Jonathan ; Kumar, Aditi ; Wheatley, Daniel ; Sinha, Ashish ; Gonzalez-reimers, Emilio ; Sanchez-pérez, María ; Ghezzi, Antonella ; David, Miruna Delia ; Corbett, Christopher ; Mccune, Anne ; Aithal, Guruprasad Padur ; Holt, Andrew ; Stewart, Stephen. / Clinical and microbiological features of infection in alcoholic hepatitis: an international cohort study. In: Journal of Gastroenterology. 2017 ; Vol. 52, No. 11. pp. 1192–1200.

Bibtex

@article{f9807b06f20a4492a1307f22bcca9aab,
title = "Clinical and microbiological features of infection in alcoholic hepatitis: an international cohort study",
abstract = "Background Previous studies have described the clinical impact of infection in alcoholic hepatitis (AH) but none have comprehensively explored the aetiopathogenesis of infection in this setting. We examined the causes, consequences and treatment of infection in a cohort of patients with AH. Methods We undertook a retrospective cohort study of patients with AH admitted between 2009 and 2014 to seven centres in Europe and the USA. Clinical and microbiological data were extracted from medical records. Survival was analysed with Kaplan–Meier analysis and Cox proportional hazards analysis to control the data for competing factors. Propensity score matching was used to examine the efficacy of prophylactic antibiotics administered in the absence of infection. Results We identified 404 patients with AH. Of these, 199 (49%) showed clinical or culture evidence of infection. Gut commensal bacteria, particularly Escherichia coli and Enterobacter species, were most commonly isolated in culture. Fungal infection was rarely seen. Cultured organisms and antibiotic resistance differed markedly between centres. Infection was an independent risk factor for death (hazard ratio for death at 90 days 2.33, 95% confidence interval 1.63–3.35, p < 0.001). Initiation of antibiotic therapy on admission in the absence of infection did not reduce mortality or alter the incidence of subsequent infections. Corticosteroid use increased the incidence of infection but this did not impact on survival. Conclusions In this large real-world cohort of patients with AH, infection was common and was associated with reduced short-term survival. Gram-negative, gut commensal bacteria were the predominant infective organisms, consistent with increased translocation of gut bacteria in AH; however, the characteristics of infection differ between centres. Infection should be actively sought and treated, but we saw no benefits of prophylactic antibiotics.",
keywords = "Hepatitis, alcoholic , Infection , Liver diseases, alcoholic ",
author = "Richard Parker and Gene Im and Fiona Jones and Hern{\'a}ndez, {Onan P{\'e}rez} and Jonathan Nahas and Aditi Kumar and Daniel Wheatley and Ashish Sinha and Emilio Gonzalez-reimers and Mar{\'i}a Sanchez-p{\'e}rez and Antonella Ghezzi and David, {Miruna Delia} and Christopher Corbett and Anne Mccune and Aithal, {Guruprasad Padur} and Andrew Holt and Stephen Stewart",
year = "2017",
month = nov,
doi = "10.1007/s00535-017-1336-z",
language = "English",
volume = "52",
pages = "1192–1200",
journal = "Journal of Gastroenterology",
issn = "0944-1174",
publisher = "Springer",
number = "11",

}

RIS

TY - JOUR

T1 - Clinical and microbiological features of infection in alcoholic hepatitis: an international cohort study

AU - Parker, Richard

AU - Im, Gene

AU - Jones, Fiona

AU - Hernández, Onan Pérez

AU - Nahas, Jonathan

AU - Kumar, Aditi

AU - Wheatley, Daniel

AU - Sinha, Ashish

AU - Gonzalez-reimers, Emilio

AU - Sanchez-pérez, María

AU - Ghezzi, Antonella

AU - David, Miruna Delia

AU - Corbett, Christopher

AU - Mccune, Anne

AU - Aithal, Guruprasad Padur

AU - Holt, Andrew

AU - Stewart, Stephen

PY - 2017/11

Y1 - 2017/11

N2 - Background Previous studies have described the clinical impact of infection in alcoholic hepatitis (AH) but none have comprehensively explored the aetiopathogenesis of infection in this setting. We examined the causes, consequences and treatment of infection in a cohort of patients with AH. Methods We undertook a retrospective cohort study of patients with AH admitted between 2009 and 2014 to seven centres in Europe and the USA. Clinical and microbiological data were extracted from medical records. Survival was analysed with Kaplan–Meier analysis and Cox proportional hazards analysis to control the data for competing factors. Propensity score matching was used to examine the efficacy of prophylactic antibiotics administered in the absence of infection. Results We identified 404 patients with AH. Of these, 199 (49%) showed clinical or culture evidence of infection. Gut commensal bacteria, particularly Escherichia coli and Enterobacter species, were most commonly isolated in culture. Fungal infection was rarely seen. Cultured organisms and antibiotic resistance differed markedly between centres. Infection was an independent risk factor for death (hazard ratio for death at 90 days 2.33, 95% confidence interval 1.63–3.35, p < 0.001). Initiation of antibiotic therapy on admission in the absence of infection did not reduce mortality or alter the incidence of subsequent infections. Corticosteroid use increased the incidence of infection but this did not impact on survival. Conclusions In this large real-world cohort of patients with AH, infection was common and was associated with reduced short-term survival. Gram-negative, gut commensal bacteria were the predominant infective organisms, consistent with increased translocation of gut bacteria in AH; however, the characteristics of infection differ between centres. Infection should be actively sought and treated, but we saw no benefits of prophylactic antibiotics.

AB - Background Previous studies have described the clinical impact of infection in alcoholic hepatitis (AH) but none have comprehensively explored the aetiopathogenesis of infection in this setting. We examined the causes, consequences and treatment of infection in a cohort of patients with AH. Methods We undertook a retrospective cohort study of patients with AH admitted between 2009 and 2014 to seven centres in Europe and the USA. Clinical and microbiological data were extracted from medical records. Survival was analysed with Kaplan–Meier analysis and Cox proportional hazards analysis to control the data for competing factors. Propensity score matching was used to examine the efficacy of prophylactic antibiotics administered in the absence of infection. Results We identified 404 patients with AH. Of these, 199 (49%) showed clinical or culture evidence of infection. Gut commensal bacteria, particularly Escherichia coli and Enterobacter species, were most commonly isolated in culture. Fungal infection was rarely seen. Cultured organisms and antibiotic resistance differed markedly between centres. Infection was an independent risk factor for death (hazard ratio for death at 90 days 2.33, 95% confidence interval 1.63–3.35, p < 0.001). Initiation of antibiotic therapy on admission in the absence of infection did not reduce mortality or alter the incidence of subsequent infections. Corticosteroid use increased the incidence of infection but this did not impact on survival. Conclusions In this large real-world cohort of patients with AH, infection was common and was associated with reduced short-term survival. Gram-negative, gut commensal bacteria were the predominant infective organisms, consistent with increased translocation of gut bacteria in AH; however, the characteristics of infection differ between centres. Infection should be actively sought and treated, but we saw no benefits of prophylactic antibiotics.

KW - Hepatitis, alcoholic

KW - Infection

KW - Liver diseases, alcoholic

U2 - 10.1007/s00535-017-1336-z

DO - 10.1007/s00535-017-1336-z

M3 - Article

VL - 52

SP - 1192

EP - 1200

JO - Journal of Gastroenterology

JF - Journal of Gastroenterology

SN - 0944-1174

IS - 11

ER -