955 Epidemiology and Outcomes of Bacterial Infections in Patients With Cirrhosis: A Single Centre Experience

Abstract

INTRODUCTION: Bacterial infection is a life-threatening condition in patients with cirrhosis, and by inducing an inflammatory state, it can precipitate acute on chronic liver failure (ACLF). However, the epidemiology and the outcome of bacterial infections are poorly understood from this resource constrained region of Asia. So we performed a prospective study to evaluate the spectrum of bacterial infections in cirrhosis patients and their outcome in hospitalized patients. METHODS: This study was conducted in consecutive decompensated cirrhosis patients hospitalised in Gastroenterology Department, SCB Medical College, Cuttack, India between October 2016 and October 2018. Demographic, clinical, laboratory and microbiological parameters were recorded in all cirrhotics and survival was compared between patients with and without infection during hospitalisation and also at 28 days and 90 days. RESULTS: 274 (47.6%) out of 576 patients had infection, of which 28.8% (n = 166) had urinary tract infection (UTI), 10.9% (n = 63) respiratory infection, 7.6% (n = 44) spontaneous bacterial peritonitis (SBP) and 3.6 % (n = 21) had skin and soft tissue infection. Culture positivity was seen in 17.5 % (n = 29) of UTI and 5 patients (11.36%) of SBP. E.coli was the commonest organism isolated from urine and ascitic fluid. Cirrhotics with bacterial infection had increased prevalence of ACLF as per CANONIC study criteria (56.9% vs 25.2%; P < 0.001). Furthermore, they had increased duration of hospitalisation (5 days vs 4 days, IQR; P < 0.001), increased hospital death (17.5% vs 5%; P < 0.001), decreased survival both at 28 days (68.6% vs 84.1%; P < 0.001) and 90 days (48.2% vs 67.9%; P < 0.001). CONCLUSION: In our institution, about half of decompensated cirrhosis patients had associated infection at the time of hospitalisation. Urinary and respiratory infections were common followed by spontaneous bacterial infection. Patients with AKI had increased proportion of ACLF, longer hospital stay, increased in hospital mortality and decreased survival both at day 28 and 90.