Bacterial Infections in Cirrhotic Patients in a Tertiary Care Hospital

Abstract

Background and Aims Patients with cirrhosis are immunocompromised and at higher risk of developing infections compared to the general population. The aim of this study was to assess the incidence of infections in cirrhotic patients in a large academic liver center and investigate potential associations between infections, bacteria isolated, therapeutic regimens used, and mortality. Methods This was a retrospective chart review study, including 192 patients. All patients had a diagnosis of cirrhosis and were admitted to University Hospital. Information collected included demographics, etiology of cirrhosis, identification of bacteria from cultures, multidrug-resistant (MDR) status, antibiotics administered, intensive care unit (ICU) admission, and patient mortality. Results Infections were present in 105 (54.6%) patients, and 60 (31.2%) patients had multiple infections during a hospitalization(s) for infections. A total of 201 infections were identified. Urinary tract infections (UTIs) were the most common infection (37.8%), followed by bacteremia (20.4%), pneumonia (12.9%), spontaneous bacterial peritonitis (SBP) (11.9%), abscess/cellulitis (6.0%), infectious diarrhea (6.0%), and other (5.0%). Escherichia coli was the most common bacteria isolated (13.4%), both among sensitive and MDR infections. MDR bacteria were the cause for 41.3% of all infections isolated. Fungi accounted for 9.5% of infections. 21.9% of patients had decompensation from their infection(s) that required ICU care, and 14.6% of patients died during hospitalization or soon after discharge. Conclusions The incidence of infections in cirrhotic patients is much higher than in their non-cirrhotic counterparts (54.6%), even higher than prior studies suggest. As many of these infections are caused by MDR bacteria and fungal organisms, stronger empiric antibiotics and antifungals should be considered when initially treating this immunocompromised population. However, once organism sensitivities are discovered, narrowing of antibiotic regimens must occur to maintain good antibiotic stewardship.

The multi-drug resistant organisms infections decrease during the antimicrobial stewardship era in cirrhotic patients: An Italian cohort study

“…Furthermore, in contrast with the study of Lingiah and al. [ 25 ], showing a higher incidence of infections, we excluded asymptomatic bacteriuria and bacterascites from the main analysis, as our SAVE guidelines do not recommend antibiotic therapy for them, in line with other similar guidelines (except for clinical features suggestive for infection) [ 26 ].…”

“…In particular the study of Lingiah and al. [ 25 ] considered in the same group asymptomatic and symptomatic infections all together.…”

A clinical observational study on the application of enhanced recovery after laparoscopic pancreaticoduodenectomy

“…The shorter retention time of urinary catheters, nasogastric tubes and intra-abdominal drains could reduce some related postoperative complications. Indwelling urinary catheters can increase the risk of postoperative lung and urinary tract infections ( 20 ), and indwelling nasogastric tubes contribute to a high risk of lung infection in patients ( 21 ), which further delays patient recovery. Moreover, a multicentre RCT showed that the absence of an intra-abdominal drain after OPD significantly increased the incidence of complications and mortality by 4 fold ( 22 ).…”

Pulmonary Bacterial Infection and Liver Cirrhosis: Current Status and Treatment

“…Overall, positive culture results are observed in 17%-28% of patients with liver cirrhosis accompanied by pulmonary bacterial infections, with gram-positive cocci (GPC) the predominant causative agents of CAP in liver cirrhosis (75%), 6,11,22 while approximately 4.8% of patients show negative culture results, even with positive imaging. 5 Table 1 lists the pathogens in CAP and HAP among cirrhotic patients. Among gram-positive bacteria, the most commonly isolated are Streptococcus pneumoniae, followed by Staphylococcus aureus and other Streptococcus species.…”

“…[1][2][3] Complications of decompensated cirrhosis include ascites, gastroesophageal variceal hemorrhage, sepsis, hepatic encephalopathy and hepatorenal syndrome. 4 Patients with liver cirrhosis are more susceptible to bacterial infections than the general population, 5 with 25%-50% of cirrhotic inpatients developing bacterial infections. 6 Cirrhotic patients with bacterial infections are more susceptible to decompensation and have a higher likelihood of mortality.…”