Frequency, characteristics and impact of multiple consecutive nosocomial infections in patients with decompensated liver cirrhosis and ascites

Abstract

Background Nosocomial infections are a particular threat for patients with liver cirrhosis. It is not uncommon that individuals develop even several consecutive infections during a single hospital stay. We aimed to investigate the impact and characteristics of multiple, consecutive nosocomial infections. Methods A total of 514 consecutive patients with liver cirrhosis and ascites were included and followed up for 28 days for nosocomial infection, death or liver transplantation (LTx). Laboratory values were assessed at the time of hospitalization as well as at the onset of each new infectious episode. Results 58% ( n = 298) of the patients developed at least one nosocomial infection and in 23% ( n = 119) even multiple infections were documented during a single hospital stay. Consecutive infections usually occurred shortly after the previous episode. Spontaneous bacterial peritonitis (SBP) was the most common infection. However, the proportion of SBP declined from 43% at the first to only 31% at the third nosocomial infection ( p = 0.096). In contrast, the likelihood for other, less common types of infection such as blood stream infections increased. Third nosocomial infections were also more likely to be linked to the detection of fungal pathogens (21% vs. 52%; p = 0.001). Each additional infectious episode had a dramatic detrimental impact on LTx-free survival that was independent from the stage of liver disease (adjusted-HR: 6.76, p = 0.002 for first nosocomial infection; adjusted-HR: 14.69, p<0.001 for second nosocomial infection; adjusted-HR: 24.95, p<0.001 for third nosocomial infection). Conclusion In patients with decompensated liver cirrhosis LTx-free survival significantly decreases with every consecutive infectious episode. Development of prevention strategies is urgently required.

Nosocomial infections in female compared with male patients with decompensated liver cirrhosis

“…However, our data emphasize that the indication for urinary catheter as well as peritoneal catheters should be critically evaluated and be removed as soon as possible 47 . This of particular importance in patients with decompensated cirrhosis who are particularly vulnerable for infections 48 , 49 .…”

Sex Specific Differences in Nosocomial Infections in Patients with Decompensated Liver Cirrhosis

“…However, our data emphasize that the indication for urinary catheter as well as peritoneal catheters should be critically evaluated and be removed as soon as possible (47). This of particular importance in patients with decompensated cirrhosis who are particularly vulnerable for infections (48,49).…”

Liver cirrosis and complication risk management

“…Также авторами показаны различия в локализации инфекционного процесса, частоте выявления разных возбудителей и в выживаемости без трансплантации печени в зависимости от количества бактериальных эпизодов. По данным авторов, показатели выживаемости без трансплантации печени (независимо от стадии заболевания) снижаются ОБЗОР в 1,7-2,2 раза с каждым дополнительным инфекционным эпизодом [17].…”