Prediction of 28‐day mortality in acute decompensation of cirrhosis through the presence of multidrug‐resistant infections at admission

Abstract

Background and Aim The aim of this study is to evaluate the epidemiology and impact of bacterial infections at admission in patients with acute decompensation (AD) of cirrhosis. Methods A cohort with AD of cirrhosis (European Association for the Study of the Liver criteria) admitted at a tertiary center was evaluated between 2013 and 2014 for the presence of bacterial infections at admission. Clinical, demographic, and microbiological data were collected prospectively till death, transplant, or 90 days. Results Of 179 patients with AD, 102 (56.9%) had bacterial infections at admission. The commonest infections were spontaneous bacterial peritonitis (SBP) (n = 65; 63.7%), spontaneous bacteremia (n = 10; 9.8%), pneumonia (n = 9; 8.8%), urinary tract infection (n = 8; 7.8%), spontaneous bacterial empyema (n = 4; 3.9%), and cellulitis (n = 2; 1.9%). The commonest source was community acquired (n = 85; 83.3%). Serum albumin and sodium levels were lower in infected as compared with non‐infected cohort (P = 0.015; for both). Escherichia coli was the commonest organism isolated from SBP (n = 14; 21.5%), urinary tract infection (n = 5; 45.5%), and bacteremia (n = 3; 20%). There was a trend toward higher 28‐day mortality in infected cohort as compared with non‐infected cohort (48 [52.7%] vs 28 [32%]; P = 0.152). Multidrug‐resistant organisms (MDROs) were isolated in 63% of all culture‐positive infections. The presence of MDRO was an independent predictor of 28‐day mortality. Conclusions Infections are the leading reason for the occurrence of AD; SBP is the most common infection, and E. coli is the commonest microorganism based on this single‐center study of Indian patients with AD of cirrhosis. There is a high prevalence of MDROs among culture‐positive infections that independently predict 28‐day mortality in AD of cirrhosis.

Pre‐transplant multidrug‐resistant infections in liver transplant recipients‐epidemiology and impact on transplantation outcome

“…Our findings are consistent with the literature, which reports that 21%–36% of cirrhotic patients develop infections, with MDRO proportions ranging from 25% to 70% 4,16–19 …”

“…Infection before LT was a frequent occurrence, with 30% of patients in our cohort affected, and a high proportion of multidrug-resistant organ- Our findings are consistent with the literature, which reports that 21%-36% of cirrhotic patients develop infections, with MDRO proportions ranging from 25% to 70%. 4,[16][17][18][19] Some studies attempted to establish an association between pre-LT infection and post-LT mortality; however, this issue remains controversial. Heldman and Cinar found that patients with pre-LT infections had a higher risk of developing post-LT infections; Cinar et al also reported an association between pre-LT infection and post-LT mortality.…”

Predictors of Mortality at 28-days in Infection associated Acute Kidney Injury in Cirrhosis

“…The previous data from India suggest higher rates of acute viral hepatitis A and E as a cause for acute insult in acute decompensation of cirrhosis and ACLF[ 11 ]. However, recent studies show a trend towards increasing rates of infection with multidrug resistant (MDR) and extremely drug resistant (XDR) bacteria in Asia[ 12 ]. The Global study showed higher prevalence of MDR (76% vs 16%) and XDR bacteria (33% vs 1%-16%) in Indian centers, as compared to Western centers respectively[ 10 ].…”

Pulmonary Bacterial Infection and Liver Cirrhosis: Current Status and Treatment

“…19,28,29 Cox regression analysis showed that mortality was higher in patients infected by MDR bacteria (OR, 4.45; 95% CI, 1.131-10.528). 19 Similarly, Gupta et al 18 found that MDR infection was an independent predictor for 28-day mortality in acute decompensation of cirrhosis (HR, 1.263; 95% CI, 1.07 -2.19; P < 0.007). Furthermore, sepsis (54.9% vs 13%) and lethal sepsis are significantly more frequent in patients with carbapenem-resistant GNB infections.…”

“…According to a global study of bacterial infections in patients with liver cirrhosis, 11 bacterial pneumonia is one of the most common infections, affecting 8.8%-28.2% of cirrhotic patients. [11][12][13][14][15][16][17][18][19] Bacterial pneumonia acquired outside of the hospital setting is termed community-acquired pneumonia (CAP), while bacterial pneumonia acquired after at least 48 hours of hospitalization is defined as hospital-acquired pneumonia (HAP) or nosocomial pneumonia. 20 Most cases of bacterial pneumonia are CAP (48%), while the proportion of HAP is 26%.…”