Global epidemiology of bacterial infections in patients with cirrhosis: A systematic review and meta-analysis.

We aimed to delineate temporal trends and geographical variations in the microbiological profiles, antimicrobial resistance (AMR) patterns, and clinical outcomes of bacterial infections in cirrhosis.

我们的目标是明确肝硬化患者细菌感染的微生物学特征、抗菌药物耐药性（AMR）模式以及临床结果的时间趋势和地理差异。

Methods

In this systematic reviewand meta-analysis(PROSPERO: CRD42024593473), we searched Embase, MEDLINE and Web of Science from inception to Nov 27, 2024, without language restrictions, for cross-sectional and cohort studies reporting microbiological characteristics, AMR patterns, and/or mortality of bacterial infections in adult patients with cirrhosis.

在这项系统评价和荟萃分析（PROSPERO: CRD42024593473）中，我们从开始到2024年11月27日，不限语言，在Embase、MEDLINE和Web of Science中检索了报告肝硬化成年患者细菌感染的微生物学特征、抗菌药物耐药性（AMR）模式和/或死亡率的横断面和队列研究。

The primary outcome was the proportion of AMR among positive bacterial cultures.

主要结果是阳性细菌培养中AMR的比例。

Secondary outcomes included bacterial distribution and mortality following bacterial infections.

次要结果包括细菌分布和细菌感染后的死亡率。

Pooled proportions were estimated using random-effects models, with subgroup analyses stratified by time period, World Health Organization region, World Bank income group, infection type and site.

使用随机效应模型估计汇总比例，根据时间段、世界卫生组织区域、世界银行收入组、感染类型和部位进行分层的亚组分析。

Results

Of 3,891 records identified, 169 studies (35,180 infected patients) were included.

在识别的3,891条记录中，共有169项研究（涉及35,180名感染患者）被纳入。

Gram-positive bacteria accounted for 32.9% (95% CI 30.3-35.5) of all positive cultures, with an increasing trend over time and higher proportion observed in high-income countries and Europe.

革兰氏阳性细菌占所有阳性培养的32.9%（95%置信区间30.3-35.5），随时间呈现增长趋势，并且在高收入国家和欧洲观察到更高的比例。

Multidrug-resistant bacteria were identified in 33.3% (95% CI 28.6-38.3) of positive cultures, with a rising temporal trend.

在阳性培养中，多重耐药细菌的检出率为33.3%（95%置信区间28.6-38.3），且呈现出上升的时间趋势。

The highest multidrug-resistant bacteria proportions were observed in low or lower-middle-income countries and in South-East Asia, and the lowest in high-income countries and the Americas.

观察到多重耐药细菌比例最高的地区是低收入或中低收入国家以及东南亚地区，而比例最低的是高收入国家和美洲地区。

A temporal declining trend in in-hospital, 30-day, and 90-day mortality rates was observed, but the reduction was less pronounced for long-term mortality.

观察到住院、30天和90天死亡率呈现时间上的下降趋势，但长期死亡率的减少不那么明显。

Conclusions

The increase of Gram-positive and AMR-related infections may inform future empirical antibiotic strategies.

革兰氏阳性菌和耐药菌感染的增加可能为未来的经验性抗生素策略提供信息。

Pronounced regional and economic disparities in infection patterns highlight the need for region-specific efforts to mitigate AMR.

感染模式中显著的地区和经济差异凸显了需要采取针对性的区域努力来减轻抗菌药物耐药性（AMR）问题。

Persistent challenges remain in reducing long-term mortality.

在降低长期死亡率方面，持续存在的挑战依然存在。

impact_and_implications

The epidemiology of bacterial infections is critical to guide clinical and public health decision-making, yet comprehensive global data remain limited.

细菌感染的流行病学对于指导临床和公共卫生决策至关重要，然而全面的全球数据仍然有限。

This systematic reviewand meta-analysisoffer a detailed global overview of microbiological profiles, antimicrobial resistance patterns, and clinical outcomes associated with bacterial infections in cirrhosis, revealing substantial temporal and geographical variations.

这项系统评价和荟萃分析提供了一个详细的全球概览，涉及肝硬化患者细菌感染的微生物学特征、抗菌药物耐药模式以及相关的临床结果，揭示了显著的时间和地理变异。

The high proportion and growing global burden of antimicrobial resistance among patients with cirrhosis underscore the urgent need for both international collaboration and context-specific national strategies.

肝硬化患者中抗菌药物耐药性的高比例和不断增长的全球负担强调了国际协作和针对性国家策略的迫切需求。

prospero_registration_number

CRD42024593473.

CRD42024593473。