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Schneitler S, Schneider C, Casper M, Lammert F, Krawczyk M, Becker SL, Reichert MC. Retrospective study of the incidence, risk factors, treatment outcomes of bacterial infections at uncommon sites in cirrhotic patients. World J Hepatol 2024; 16:418-427. [PMID: 38577541 PMCID: PMC10989312 DOI: 10.4254/wjh.v16.i3.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/02/2024] [Accepted: 02/08/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Bacterial infections (BI) negatively affect the natural course of cirrhosis. The most frequent BI are urinary tract infections (UTI), pneumonia, and spontaneous-bacterial peritonitis (SBP). AIM To assess the relevance of bacterial infections beyond the commonly recognized types in patients with cirrhosis and to investigate their relationship with other clinical variables. METHODS We retrospectively analyzed patients with cirrhosis and BI treated between 2015 and 2018 at our tertiary care center. BIs were classified as typical and atypical, and clinical as well as laboratory parameters were compared between the two groups. RESULTS In a cohort of 488 patients with cirrhosis, we identified 225 typical BI (95 UTI, 73 SBP, 72 pulmonary infections) and 74 atypical BIs, predominantly cholangitis and soft tissue infections (21 each), followed by intra-abdominal BIs (n = 9), cholecystitis (n = 6), head/throat BIs (n = 6), osteoarticular BIs (n = 5), and endocarditis (n = 3). We did not observe differences concerning age, sex, or etiology of cirrhosis in patients with typical vs atypical BI. Atypical BIs were more common in patients with more advanced cirrhosis, as evidenced by Model of End Stage Liver Disease (15.1 ± 7.4 vs 12.9 ± 5.1; P = 0.005) and Child-Pugh scores (8.6 ± 2.5 vs 8.0 ± 2; P = 0.05). CONCLUSION Atypical BIs in cirrhosis patients exhibit a distinct spectrum and are associated with more advanced stages of the disease. Hence, the work-up of cirrhosis patients with suspected BI requires detailed work-up to elucidate whether typical BI can be identified.
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Affiliation(s)
- Sophie Schneitler
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg 66421, Germany.
| | - Christina Schneider
- Department of Medicine II, Saarland University Medical Center, Homburg 66421, Germany
| | - Markus Casper
- Department of Medicine II, Saarland University Medical Center, Homburg 66421, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg 66421, Germany
- Health Sciences, Hannover Medical School, Hannover 30625, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Homburg 66421, Germany
- Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Centre for Preclinical Research, Medical University of Warsaw, Warsaw 02-097, Poland
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg 66421, Germany
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Iqbal A, Gangwani MK, Beran A, Dahiya DS, Sohail AH, Lee-Smith W, Aziz M, Hassan M. Nosocomial vs healthcare associated vs community acquired spontaneous bacterial peritonitis: Network meta-analysis. Am J Med Sci 2023; 366:305-313. [PMID: 37394136 DOI: 10.1016/j.amjms.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/24/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Spontaneous bacterial peritonitis (SBP) is a common complication in decompensated liver cirrhosis with ascitic fluid polymorphonuclear cell count > 250/mm3. Community acquired SBP (CA-SBP) occurs within the first 48 hours after hospital admission. Nosocomial SBP (N-SBP) occurs 48-72 hours after hospitalization. Healthcare associated SBP (HA-SBP) occurs in patients hospitalized in the preceding 90 days to months. We aim to evaluate mortality and resistance patterns to third generation cephalosporin among the three types. METHODS Multiple databases were systematically searched from inception through August 1st, 2022. Both pairwise (direct) and network (direct + indirect) meta-analysis was performed using a random effects model and DerSimonian Laird approach. Relative Risk (RR) with 95% confidence intervals (CI) were calculated. Network meta-analysis was conducted using frequentist approach. RESULTS A total of 14 studies with a total of 2302 SBP episodes were evaluated. On direct meta-analysis, mortality rate was higher in N-SBP compared to HA-SBP (RR 1.84, CI 1.43- 2.37) and CA-SBP (RR 1.69, CI 1.4-1.98), but not significantly different between HA-SBP and CA-SBP (RR=1.40, CI=0.71-2.76). Resistance to third generation cephalosporins was significantly higher in N-SBP compared to HA-SBP (RR=2.02, CI 1.26-3.22) and CA-SBP (RR=3.96, CI=2.50-3.60) as well as in HA-SBP compared to CA-SBP (RR=2.25, CI=1.33-3.81). CONCLUSIONS Our network meta-analysis shows increased mortality and antibiotic resistance with nosocomial SBP. We recommend clearly identifying such patients to manage accordingly as well as developing guidelines geared towards nosocomial infections to be able to optimally steer resistance patterns and reduce mortality.
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Affiliation(s)
- Amna Iqbal
- Department of Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | | | - Azizullah Beran
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indiana, USA
| | | | - Amir Humza Sohail
- Department of General Surgery, New York University Langone Health, Long Island, NY,USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, Ohio, USA
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Mona Hassan
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA
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Jiang Y, Fan C, Dang Y, Zhao W, Lv L, Lou J, Li L, Ding H. Clinical Characteristics and Early Diagnosis of Spontaneous Fungal Peritonitis/Fungiascites in Hospitalized Cirrhotic Patients with Ascites: A Case-Control Study. J Clin Med 2023; 12:jcm12093100. [PMID: 37176540 PMCID: PMC10179646 DOI: 10.3390/jcm12093100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/24/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Spontaneous fungal peritonitis (SFP) and fungiascites is less well-recognized and described in patients with liver cirrhosis. The aims of this study were to determine the clinical characteristics, prognosis, and risk factors of cirrhotic patients with SFP/fungiascites and to improve early differential diagnosis with spontaneous bacterial peritonitis (SBP). METHODS This was a retrospective case-control study of 54 cases of spontaneous peritonitis in cirrhotic patients (52 SFP and 2 fungiascites) with fungus-positive ascitic culture. Fifty-four SBP cirrhotic patients with bacteria-positive ascitic culture were randomly enrolled as a control group. A nomogram was developed for the early differential diagnosis of SFP and fungiascites. RESULTS Hospital-acquired infection was the main cause of SFP/fungiascites. Of the 54 SFP/fungiascites patients, 31 (57.41%) patients carried on with the antifungal treatment, which seemed to improve short-term (30-days) mortality but not long-term mortality. Septic shock and HCC were independent predictors of high 30-day mortality in SFP/fungiascites patients. We constructed a predictive nomogram model that included AKI/HRS, fever, (1,3)-β-D-glucan, and hospital-acquired infection markers for early differential diagnosis of SFP/fungiascites in cirrhotic patients with ascites from SBP, and the diagnostic performance was favorable, with an AUC of 0.930 (95% CI: 0.874-0.985). CONCLUSIONS SFP/fungiascites was associated with high mortality. The nomogram established in this article is a useful tool for identifying SFP/fungiascites in SBP patients early. For patients with strongly suspected or confirmed SFP/fungiascites, timely antifungal therapy should be administered.
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Affiliation(s)
- Yingying Jiang
- Department of Hepatology and Gastroenterology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
| | - Chunlei Fan
- Department of Hepatology and Gastroenterology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
| | - Yan Dang
- Clinical Laboratory Center, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
| | - Wenmin Zhao
- Department of Hepatology and Gastroenterology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
| | - Lingna Lv
- Department of Hepatology and Gastroenterology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
| | - Jinli Lou
- Clinical Laboratory Center, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
| | - Lei Li
- Department of Hepatology and Gastroenterology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
| | - Huiguo Ding
- Department of Hepatology and Gastroenterology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
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Choudry N, Sasso R, Rockey DC. Infection in Hospitalized Cirrhosis Patients: Changing Epidemiology and Clinical Features. Am J Med Sci 2022; 363:114-121. [PMID: 34995572 DOI: 10.1016/j.amjms.2021.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/29/2021] [Accepted: 10/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with cirrhosis are uniquely predisposed to infections, which can lead to acute decompensation and an increase in mortality rates. We hypothesized that not only are cirrhotic patients more likely to develop certain infections, but that specific infections are associated with poorer outcomes. Therefore, we aimed to examine the epidemiology, bacteriology, and outcomes of infections in cirrhotic patients admitted to the hospital. METHODS In this single center observational retrospective cohort study, we identified admissions in which patients had an infection from a group of all admissions of cirrhotics from 2011-2016. Infections were categorized by the primary source of infection, and rigorous clinical and bacteriologic definitions were used. RESULTS We identified 1,208 admissions in 877 unique patients during the study period. The most common infections identified were as follows: urinary tract infections (33%), pneumonia (23%), spontaneous bacterial peritonitis (14%), and bacteremia (11%). Gram-positive organisms were most commonly isolated in patients with spontaneous bacterial peritonitis and bacteremia, whereas gram-negative bacteria were most prevalent in urinary tract infections and pneumonia. Candida infections were common and identified in the following proportions: spontaneous bacterial peritonitis (16%), pneumonia (14%), bacteremia (13%), and urinary tract infections (9%). Pneumonia, spontaneous bacterial peritonitis, and meningitis were associated with increased mortality rates (29%, 32%, and 67%, respectively), compared to the overall mortality rate of 20% (p-value < 0.05). CONCLUSIONS In summary, infections were common in patients with cirrhosis and were associated with poor outcomes, particularly in the presence of evidence of sepsis. Spontaneous bacterial peritonitis and bacteremia are now most commonly due to gram-positive organisms and fungal infections appear to be rising in prevalence.
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Affiliation(s)
- Nida Choudry
- Division of Gastroenterology and Hepatology, and the Digestive Disease Research Center, Medical University of South Carolina, Charleston, South Carolina
| | - Roula Sasso
- Division of Gastroenterology and Hepatology, and the Digestive Disease Research Center, Medical University of South Carolina, Charleston, South Carolina
| | - Don C Rockey
- Division of Gastroenterology and Hepatology, and the Digestive Disease Research Center, Medical University of South Carolina, Charleston, South Carolina.
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Campbell KA, Trivedi HD, Chopra S. Infections in Cirrhosis: A Guide for the Clinician. Am J Med 2021; 134:727-734. [PMID: 33607090 DOI: 10.1016/j.amjmed.2021.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/31/2020] [Accepted: 01/25/2021] [Indexed: 12/13/2022]
Abstract
Cirrhosis contributes significantly to morbidity and mortality worldwide. Infections in patients with cirrhosis are common and significantly impact health-related quality of life. As our understanding of immune dysfunction associated with cirrhosis grows and as rates of drug-resistant organisms increase, the management of infections in cirrhosis has become increasingly nuanced. In this review, we discuss the current understanding of cirrhosis-associated immune deficiency, review the most common infections in patients with cirrhosis, and highlight techniques for the general clinician in the prevention and treatment of infections in this high-risk population.
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Affiliation(s)
- Kirsti A Campbell
- Beth Israel Deaconess Medical Center, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Hirsh D Trivedi
- Beth Israel Deaconess Medical Center, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Sanjiv Chopra
- Beth Israel Deaconess Medical Center, Boston, Mass; Harvard Medical School, Boston, Mass
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Figueiredo LM, Rafael MA, Alexandrino G, Branco JC, Carvalho R, Costa MN, Martins A. Risk factors for the emergence of multidrug-resistant organisms in liver cirrhosis. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:186-191. [PMID: 34052400 DOI: 10.1016/j.gastrohep.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/14/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multidrug-resistant organisms (MDROs) are a reality that can alter the paradigm of treatment and prevention of infection in patients with liver cirrhosis (LC). OBJECTIVE Identify risk factors for the occurrence of MDROs in patients with LC. PATIENTS AND METHODS Prospective study from October 2017 to March 2018 in consecutively hospitalized patients with decompensated LC with infection. Blood, urine and ascitic fluid cultures were analyzed. A p-value ≤0.05 was considered statistically significant. RESULTS MDROs isolated in 18 of 52 episodes of infection. MDROs were associated with the use of proton pump inhibitors (PPIs) (p=0.0312), antibiotic therapy in the last 90 days (p=0.0033) and discharge within preceding 30 days or current hospitalization above 48h (p=0.0082). There was higher 90-day mortality in patients with MDROs infection (71.4% versus 35.7%, p=0.0316). CONCLUSION MDROs infections were prevalent in this cohort and associated with 90-day mortality. Use of PPIs and antibiotics increased the risk of MDROs infections, suggesting that its prescription should be restricted to formal indication. Hospitalization was associated with the onset of MDROs, so LC patients should stay at the hospital the least possible. It is relevant to investigate other factors predisposing to the emergence of these microorganisms, in order to prevent it.
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Affiliation(s)
| | - Maria Ana Rafael
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, Portugal
| | - Gonçalo Alexandrino
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, Portugal
| | - Joana C Branco
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, Portugal
| | - Rita Carvalho
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, Portugal
| | - Mariana Nuno Costa
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, Portugal
| | - Alexandra Martins
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, Portugal
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Hsu JY, Chuang YC, Wang JT, Chen YC, Hsieh SM. Healthcare-associated carbapenem-resistant Klebsiella pneumoniae bloodstream infections: Risk factors, mortality, and antimicrobial susceptibility, 2017-2019. J Formos Med Assoc 2021; 120:1994-2002. [PMID: 33962811 DOI: 10.1016/j.jfma.2021.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In Taiwan, carbapenem-resistant Klebsiella pneumoniae (CRKP) now became a leading cause of difficult-to-treat healthcare-associated infection, for which there are a lack of recent hospital epidemiological studies on risk factors, mortality, and antimicrobial susceptibility. METHODS We prospectively enrolled patients with healthcare-associated CRKP monomicrobial bloodstream infection (mBSI) and matched patients with carbapenem susceptible K. pneumoniae (CSKP) mBSI at National Taiwan University Hospital (Taipei, Taiwan) from October 2017 through December 2019 in a 1:2 ratio. Multivariable logistic regression and Kaplan-Meier analyses were applied to identify factors associated with CRKP mBSI and to compare the 14-day survival curves, respectively. We detected the presence of blaKPC and blaNDM gene among the included CRKP strains, and performed antimicrobial susceptibility testing (including susceptibility to colistin, aminoglycoside, tigecycline, and ceftazidime/avibactam). RESULTS A total of 36 CRKP cases and 72 CSKP controls were enrolled. Patients with CRKP mBSI were more likely to have liver cirrhosis (adjusted odds ratio [aOR], 5.61; P = 0.024), length of hospital stay over the previous 14 days (aOR, 1.23; P = 0.001) and prior use of carbapenems in the previous 14 days (aOR, 6.07; P = 0.004) than patients with CSKP mBSI. The 14-day survival was significantly worse for patients with CRKP mBSI than those with CSKP mBSI (all CRKP cases: 50.0% vs. 87.5%; P < 0.001; CRKP cases treated with colistin as an appropriate backbone antibiotic: 58.3% vs. 87.5%; P = 0.007). Compared with the CSKP isolates, CRKP isolates were significantly less susceptible to colistin, amikacin, and tigecycline. Of the 36 CRKP isolates, none harbor blaNDM gene and 35 (97%) had low minimum inhibitory concentrations (≤8/4 μg/ml) of ceftazidime/avibactam by the E test method. CONCLUSION Prior exposure to carbapenems, longer hospital stay, and the presence of liver cirrhosis predicted CRKP instead of CSKP mBSI. Even with colistin therapy, CRKP mBSIs was still associated with a very high risk of mortality within 14 days. Ceftazidime/avibactam is a potentially useful therapeutic choice for cases caused by in vitro susceptible CRKP strains.
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Affiliation(s)
- Jen-Yu Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yu-Chung Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yee-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Szu-Min Hsieh
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Juárez-Hernández E, Uribe M. The lack of guidelines and government policies for regulating nonprescription sale of antibiotics and its medical consequences. Ann Hepatol 2020; 18:783-785. [PMID: 31735347 DOI: 10.1016/j.aohep.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Eva Juárez-Hernández
- Translational Research Unit, Medica Sur Clinical Foundation, Mexico City, Mexico
| | - Misael Uribe
- Translational Research Unit, Medica Sur Clinical Foundation, Mexico City, Mexico; Gastroenterology and Obesity Unit, Medica Sur Clinical Foundation, Mexico City, Mexico.
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Piotrowski D, Sączewska-Piotrowska A, Jaroszewicz J, Boroń-Kaczmarska A. Lymphocyte-To-Monocyte Ratio as the Best Simple Predictor of Bacterial Infection in Patients with Liver Cirrhosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051727. [PMID: 32155772 PMCID: PMC7084714 DOI: 10.3390/ijerph17051727] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/01/2020] [Accepted: 03/04/2020] [Indexed: 12/17/2022]
Abstract
Background and aim: The aim of this study was to assess the diagnostic performance of new morphology-related indices and Child–Turcotte–Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores during hospitalization in predicting the onset of bacterial infection in patients with liver cirrhosis. Material and methods: A total of 171 patients (56.9% males; median age 59 years; total number of hospitalizations 209) with liver cirrhosis were included in this observational study. The diagnosis of cirrhosis was made on the basis of clinical, biochemical, ultrasonic, histological, and endoscopic findings. The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), modified aspartate aminotransferase-to-platelet ratio index (APRI), aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), Fibrosis-4 index (FIB-4), platelet-to-lymphocyte ratio (PLR), neutrophil-to-monocyte ratio (NMR), and CTP and MELD scores were calculated for the cases of patients with cirrhosis. Results: Bacterial infection was diagnosed in 60 of the 209 (28.7%) hospitalizations of patients with cirrhosis. The most common infections were urinary tract infection (UTI), followed by pneumonia and sepsis. The more severe the liver failure, the greater the bacterial infection prevalence and mortality. Patients with decompensated liver cirrhosis were infected more often than subjects with compensated cirrhosis (50.0% vs. 12.9%, p = 0.003). The calculated MELD score, CTP, NLR, LMR, AAR, monocyte count, and C-reactive protein (CRP) concentration were also related to the bacterial infection prevalence, and mortality areas under the curve (AUC) were 0.629, 0.687, 0.606, 0.715, 0.610, 0.648, and 0.685, respectively. The combined model with two variables (LMR and CTP) had the best AUC of 0.757. The most common bacteria isolated from patients with UTI were Escherichia coli, Enterococcus faecalis, and Klebsiella pneumonia. Gram-negative bacteria were also responsible for spontaneous bacterial peritonitis (SBP), and together with gram-positive streptococci and staphylococci, these microorganisms were isolated from blood cultures of patients with sepsis. Significant differences were found between CTP classification, MELD score, NLR, LMR, AAR, CRP, and PLR in patients with cirrhosis with, or without, bacterial infection. Conclusions: Bacterial infection prevalence is relatively high in patients with liver cirrhosis. Although all analyzed scores, including the LMR, NLR, aspartate aminotransferase (AST)/alanine aminotransferase (ALT), CRP, CTP, and MELD, allowed the prediction of bacterial occurrence, the LMR had the highest clinical utility, according to the area under the curve (AUC) and odds ratio (OR).
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Affiliation(s)
- Damian Piotrowski
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, 40-055 Katowice, Poland;
- Correspondence: ; Tel.: +48-501-492-461
| | - Anna Sączewska-Piotrowska
- Department of Labour Market Research and Forecasting, University of Economics, 40-287 Katowice, Poland;
| | - Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Anna Boroń-Kaczmarska
- Department of Infectious Diseases, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland;
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Sousa Cardoso F. Bacterial Infections in Patients with Cirrhosis Admitted to the Hospital. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 26:312-313. [PMID: 31559321 PMCID: PMC6751434 DOI: 10.1159/000495769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 11/22/2018] [Indexed: 06/10/2023]
Affiliation(s)
- Filipe Sousa Cardoso
- Intensive Care Unit, Curry Cabral Hospital, Central Lisbon Hospital Center, Nova University, Lisbon, Portugal
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