studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 937A
GPC in culture-positive SBP and/or bacteremia were observed.
Patients with GNB had more advanced liver disease and more
severe inflammatory response compared to GPC ones. A variety
of drug-resistant microorganisms and a high rate of E. Faecium
have emerged. Due to high rates of resistance in currently
recommended therapy and prophylaxis, the choice of optimal
antibiotic therapy should be individualized.
Disclosures:
The following authors have nothing to disclose: Alexandra Alexopoulou, Larisa E.
Vasilieva, Sotiria Papadaki, Danai Agiasotelli, Sophia Pouriki, Athanasia Tsiriga,
Marina G. Toutouza, Spyros P. Dourakis
Disclosures:
Joseph K. Lim - Consulting: Merck, Boehringer-Ingelheim, Gilead, Bristol Myers
Squibb, Janssen; Grant/Research Support: AbbVie, Boehringer-Ingelheim, Bristol
Myers Squibb, Gilead, Hologic, Janssen
Matthew Budoff - Grant/Research Support: GE, NIH
The following authors have nothing to disclose: Kaku So-Armah, Janet Tate, Vincent
Lo Re, Vincent Marconi, Jeffrey Samet, Cynthia Gibert, David Leaf, Adeel
Butt, Matthew B. Goetz, David Rimland, Maria C. Rodriguez-Barradas, Chung-
Chou Chang, Amy Justice, Matthew Freiberg
1489
Increasing frequency of gram-negative multi-drug resistant
bacteria and Enterococcus faecium in spontaneous
bacterial peritonitis and bacteremia in patients with
decompensated cirrhosis
Alexandra Alexopoulou 1 , Larisa E. Vasilieva 1 , Sotiria Papadaki 1 ,
Danai Agiasotelli 1 , Sophia Pouriki 1 , Athanasia Tsiriga 2 , Marina
G. Toutouza 2 , Spyros P. Dourakis 1 ; 1 2nd Dept of Medicine, Medical
School University of Athens, Athens, Greece; 2 Microbiology
Department Hippokration GNA, Athens, Greece
Purpose/Background: Spontaneous bacterial peritonitis (SBP)
and bacteremia in cirrhotic patients are historically caused
by Gram-negative bacteria (GNB) almost exclusively Enterobacteriaceae.
Recently, an increasing rate of infections with
Gram-positive cocci (GPC) and multi-drug resistant (MDR)
microorganisms was demonstrated. The purpose of this study
was to assess possible recent changes of the bacteria causing
SBP or bacteremia in patients with decompensated cirrhosis.
Methods: We prospectively recorded 130 cases (68.5%
males) with culture-positive SBP or spontaneous bacteremia
without SBP during a 3-year-period (2012-2014). Results: The
76.2% of patients had health care-associated (HCA) or nosocomial
infections. GPC were found in half of the cases. The most
prevalent organisms in a descending order were E. coli (33),
Enterococcus spp (30, including 17 E. Faecium), Streptococcus
spp (25), K. pneumonia (16), S. aureus (8), P. aeruginosa
(5), other GNB (11) and anaerobes (2). Twenty five (19.2%)
of the isolated bacteria were MDR, including extended-spectrum-beta-lactamase-producing
(ESBL)-GNB (9), carbapenemase-producing
(KPC)-K. pneumonia (5), P. aeruginosa (5), A.
baumannii (2), E. Faecium Vancomycin-resistant (2), KPC colistin-Resistant-K.
pneumonia (1) and metallo-Β-Lactamase producing
(MBL)-E. Coli (1). MDR bacteria were more frequently
isolated in HCA/nosocomial than in community-acquired infections
(100% vs 70.5%) (P=0.002). E. Faecium was always
associated with HCA/nosocomial infections. Patients with MDR
bacteria or E. Faecium had longer hospitalization compared
to the rest of patients (P=0.013). Patients with GNB had more
advanced liver disease and higher neutrophil-to-leucocyte ratio
compared to those with GPC [MELD 21 (17-26) vs 18 (13-
25) respectively, (P=0.059), total bilirubin 4.98 (2,2-11,1) vs
2.75 (1.79-5.90) respectively, (P=0.046] and [84 (74-91) vs
78 (69-85) respectively, (P=0.018)]. Third-generation cephalosporin-resistance
was observed in 43.1% and quinolone-resistance
in 49.6%. Conclusion: Similar frequencies of GNB and
1490
Non-invasive assessment of portal hypertensive gastropathy:
feasibility of contrast-enhanced ultrasonography
for stomach wall
Hitoshi Maruyama, Soichiro Kiyono, Takayuki Kondo, Tadashi
Sekimoto, Osamu Yokosuka; Department of Gastroenterology
and Nephrology, Chiba University Graduate School of Medicine,
Chiba, Japan
Background/Aim: Portal hypertensive gastropathy (PHG) is one
of the major complications in cirrhosis, and endoscopy may be
the only diagnostic tool. The analysis of microbubble-induced
enhancement of the stomach wall on the sonogram may detect
the hemodynamic difference between patients with and without
PHG. The aim was to elucidate the efficacy of transabdominal
contrast-enhanced ultrasound (CEUS) as a non-invasive
diagnostic tool of PHG. Methods: This is a prospective study
performed in 54 subjects, 40 cirrhosis patients (60.4 ± 10.5
years; 11 females; Child A 25, B 15) with esophageal varices
who underwent the measurement of hepatic venous pressure
gradient (HVPG) and 14 controls (41.4 ± 13.1 years; female
4). Contrast effects using perflubutane microbubble agent
were assessed at the upper stomach wall by CEUS. The peak
enhancement time (PT, time from contrast onset to maximum
enhancement) and the intensity ratio between pre-enhancement
and peak-enhancement (IR) were calculated using time-intensity
curve. Results: PHG was detected in 15 cirrhosis patients
(37.5 %; mild 12, severe 3). The PT and IR were 8.5s and
8.3s (p=0.348), and 1.22 and 1.56 (p