Epidemiology, etiology and severity of community onset bacterial infections in patients with liver cirrhosis according with disease history and severity

INTRODUCTION: Bacterial infections are a leading cause of morbidity and mortality in patients with liver cirrhosis (LC). The objective of this study was to describe the epidemiology, cause and severity of infection in patients with LC according with stage of disease.
METHODS: We conducted a 2 year prospective observational study where consecutive patients with LC and bacterial infections were included. At baseline, we collected the following prognostic scores: number of previous Acute Decompensations (AD), Model for End-stage Liver Disease (MELD), Child-Turcotte-Pugh, CLIF-OF, CLIF-AD and CLIF-ACLF scores. Patient transplant-free survival was assessed at hospital discharge.
RESULTS: Patients with less advanced disease (≤ 2 previous episodes of AD) had more frequently spontaneous bacterial peritonitis (SBP) (P=0.02) and culture-negative infections (P=0.01). Conversely, patients with > 2 episodes had more frequently device related infection (P=0.011), such as catheter related BSIs or TIPSS infections and infection caused by multidrug-resistant (MDR) pathogen (Table 2). Infection severity did not change significantly among the two groups. In-hospital morality was 16%, with no significative differences (17% vs 13%, P=0.49).
CONCLUSION: In patients with LC admitted for a community-onset bacterial infection, the anamnesis of more than 2 previous AD is a possible risk factor predicting site of infection (device-related infections vs PBS) and a higher probability of a MDR etiology.

Lorenzo Marconi
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