Abstract: BACKGROUND & AIMS: Bacterial infections are a frequent and serious burden among patients with cirrhosis; they can further deteriorate liver function. We assessed the epidemiology, risk factors, and clinical consequences of bacterial infections in hospitalized cirrhotic patients.
METHODS: In a cohort of hospitalized cirrhotic patients (n=150), referred to a tertiary care setting, all episodes of bacterial infections were prospectively recorded. Infections were classified as community-acquired (CA), health-care-associated (HCA), or hospital-acquired (HA). Site of infection, characteristics of bacteria, and prevalence of antibiotic resistance were reported; consequences for liver function and patient survival were evaluated.
RESULTS: Fifty-four infections were observed among 50 patients (12 CA, 22 HCA, and 20 HA). Bacterial resistance was more frequent among patients with HCA or HA infections (64% of isolates). Mortality was 37% from HA, 36% from HCA, and 0% from CA infections. Independent predictors of infection included a previous infection within the last 12 months (P=.0001; 95% CI: 2.2-10.6), MELD score >/=15 (P=.01; 95% CI: 1.3-6.1), and protein malnutrition (p=.04; 95% CI: 1.5-10). Infectious episodes worsened liver function in 62% of patients. Patients with infection more frequently developed ascites, hepatic encephalopathy, hyponatremia, hepato-renal-syndrome, or septic shock. Child class C (P=.006; 95%CI: 1.67-23.7), sepsis (P=.005; 95% CI: 1.7-21.4), and protein malnutrition (P=.001; 95% CI: 2.8-38.5) increased mortality among patients in the hospital.
CONCLUSIONS: In hospitalized cirrhotic patients, the most frequent infections are HCA and HA; infections are frequently resistant to antibiotics. As infections worsen, liver function deteriorates and mortality increases. Cirrhotic patients should be closely montitored for infections.