Are there differences in risk factors, microbial aspects, and prognosis of cellulitis between compensated and decompensated hepatitis C virus-related cirrhosis?

Abstract

Background/AimsCellulitis is a common infection in patients with liver cirrhosis. We aimed to compare risk factors, microbial aspects, and outcomes of cellulitis in compensated and decompensated hepatitis C virus (HCV)-related cirrhosis.MethodsSix hundred twenty consecutive HCV-related cirrhotic patients were evaluated for cellulitis. Demographic and clinical data were evaluated, along with blood and skin cultures. Severity of cirrhosis was assessed using Child-Pugh score. In-hospital mortality was assessed.ResultsSeventy-seven (12.4%) cirrhotic patients had cellulitis (25 with compensated and 52 with decompensated disease). Smoking and venous insufficiency were risk factors of cellulitis in compensated cirrhosis. Leg edema, ascites, hyperbilrubinemia and hypoalbuminemia were risk factors in decompensated cirrhosis. Gram-positive bacteria (Staphylococcus spp. and Streptococcus pyogenes) were the infective organisms in compensated patients, while gram negative bacteria (Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) were the predominant organisms in decompensated cirrhosis. Fungi (Candida albicans and Aspergillus niger) were detected in 3 decompensated cases. In-hospital mortality in patients with cellulitis was 27.3%, approaching 100% in decompensated patients with gram-negative cellulitis. Prolonged hospitalization, higher model for end-stage liver disease (MELD)-Na score, septic shock, local complication, and recurrent cellulitis were predictors of mortality.ConclusionsCellulitis in compensated cirrhosis is different from that of decompensated patients regarding microorganisms, pathogenesis, and prognosis. Cellulitis has a poor prognosis, with mortality rates approaching 100% in decompensated patients with gram-negative cellulitis. Stratifying patients according to severity of cirrhosis is important to identify the proper empirical antibiotic and to decide the proper means of care.

Epidemiological Trend of Sepsis in Patients with Hospital Admissions Related to Hepatitis C in Spain (2000–2015): A Nationwide Study

“…Several studies have shown an increased risk of bacterial infection and sepsis in HCV-infected patients [ 14 , 15 , 62 ], even if they have not developed cirrhosis [ 10 , 16 ]. In HCV-infected patients, invasive pneumococcal disease [ 9 ] and Staphylococcus aureus infection [ 63 ] are among the most common bacterial infections.…”

Bacterial infections in cirrhosis: a narrative review and key points for clinical practice

“…49 Advanced liver disease, MELD score >15, serum albumin <2.5 g/dL are the major liver-related risk factors for cellulitis. [49][50][51] No RCTs for antibiotic therapy of cellulitis in a cirrhotic setting where published. Anyway, as observation- ally reported, initial empirical therapy with cephalosporin or amoxicillin-clavulanic acid or piperacillin-tazobactam should be suggested, but a switch therapy for failure or microbiological guide is necessary in 1/3 of cases.…”

“…Anyway, as observation- ally reported, initial empirical therapy with cephalosporin or amoxicillin-clavulanic acid or piperacillin-tazobactam should be suggested, but a switch therapy for failure or microbiological guide is necessary in 1/3 of cases. [49][50][51] Furthermore, EASL guidelines recommend empirical antimicrobial therapy in community-acquired skin and soft tissue infection by piperacillin-tazobactam or 3 rd generation cephalosporin + oxacillin, while in the setting of healthcare or nosocomial infection, 3 rd generation cephalosporin or meropenem + oxacillin or glycopeptide or daptomycin or linezolid 27 (Table 1 12,29 ). Treatment should last an average of 7 days.…”