Urinary tract infections among adults with decompensated liver cirrhosis at a large urban health facility in Uganda

Abstract

Background Decompensated cirrhosis is a major cause of morbidity and mortality globally affecting close to 10.6 million people of which an estimated 28,877 are in Uganda. Bacterial infections including urinary tract infections (UTIs) are an increasing cause of short-term mortality in this sub-population. Data on UTIs among patients with cirrhosis are scarce in Uganda and other settings in sub-Saharan Africa (SSA) which suffer a high burden of liver diseases. We determined the prevalence, microbiologic spectrum and antibacterial sensitivity patterns of UTIs among patients with decompensated cirrhosis at a large urban health facility in Uganda. Methods Patients with decompensated cirrhosis presenting to a tertiary care centre in Uganda were enrolled in the study. Demographic and clinical features of UTI were captured and urine samples collected. Urinalysis and urine culture studies were conducted to determine presence of UTIs and antibacterial susceptibility patterns. Urinalysis results of ≥ 5 white cells per high power field and or culture findings of ≥ 104CFUs/ml defined UTI. Analysis was done using STATA 16.0 and findings summarized in percentages. Results Irrespective of symptomatology, prevalence of UTI was 37.1% (106/286) on either urinalysis alone 11/286 (3.9%), urine culture alone 77/286 (26.9%) or both 18/286 (6.3%). The most common bacteria isolated were Escherichia coli (40.1%) and Enterococcus spp (22.9%). The majority of isolates were resistant to fluoroquinolones, penicillins and third generation cephalosporins. Multidrug resistant organisms particularly ESBL and MRSA constituted 32.7% of the bacterial isolates. Conclusion Urinary tract infection is common among patients with decompensated cirrhosis, occurring in one third of patients with cirrhosis and are commonly caused by gram negative bacteria resistant to commonly recommended antibacterial agents in Uganda. Regardless of symptomatology, we recommend screening of patients with decompensated cirrhosis for UTI at presentation.