28. Infections in patients with liver cirrhosis: a tertiary care centre study from South India

Abstract

Background and Aims: Patients with cirrhosis are immunocompromised and increased susceptibility to develop spontaneous bacterial infections, hospital-acquired infections, and a variety of infections from uncommon pathogens. Once infection develops, the excessive response of pro-inflammatory cytokines on a pre-existing hemodynamic dysfunction in cirrhosis further predispose the development of serious complications such as shock, acute-on- chronic liver failure, renal failure, and death. The aim of this study was to determine the prevalence, localization and etiology of infections in hospitalized patients with liver cirrhosis. Methods: This retrospective study included 290 patients with liver cirrhosis hospitalized at Department of Medical Gastroenterology, NIMS, Hyderabad, Telangana from April 2017 to March 2018. Infections were diagnosed according to clinical examination, laboratory findings, radiological examination, endoscopy and bacterial positive culture. Results: Most common etiology of cirrhosis was ethanol (70.65%) followed by chronic viral hepatitis (15.21%). The prevalence of infections was 39.3% (114/290). The most common infections were spontaneous bacterial infection (26.3%), urinary tract infection (UTI) (17.5%), Pneumonia (10.5%) and cellulitis (7.9%). Localization of infection remained undetermined in 20 patients (17.5%). Bacterial infections were most common (65.79%) followed by fungal infections (12.28%) and TB (6.1%). The inpatient mortality rate among patients with infections was 15.8% (18/114). 19 patients (16.67%) were culture positive - 14/20 of UTI, 2/12 of Pneumonia and 3 were primary bacteremia. Conclusions: Infections are often found in patients with liver cirrhosis, the most frequent being spontaneous bacterial peritonitis, urinary tract infection and pneumonia. Localization of infections fails in substantial number of patients with sepsis. The authors have none to declare.