English

Abstract

BACKGROUND Cirrhosis is an immunocompromised state that predisposes patients to spontaneous bacterial infections, hospital-acquired infections, and a variety of infections from uncommon pathogens. The incidence of antibiotic resistant pathogens has been increasingly detected, especially in healthcare-associated settings. In this era of highly effective antibiotics, infections are still found to be major cause for hospitalisation and mortality in patient with CLD (chronic liver disease). Viral infections and viral translocations in cirrhosis needs more data and research to comment at present. No recent data available about bacterial infections and resistance pattern in cirrhotic patients in our region including Kerala region (South India). There is a need to produce data regarding this, which can help to identify the burden and need for newer strategies. METHODS This is a retrospective study conducted in Department of Gastroenterology, Pushpagiri Medical College, Thiruvalla, from September 2018 to January 2019. A preliminary chart review of 30 patients showed that 46% had SBP. Sample size calculated was 95 for alpha error of 1.96 with an absolute precision of 10%. Consecutive 100 patients (approximated sample size) admitted with culture proven infections (except in skin and soft tissue infections) were evaluated between September 2018 to January 2019. Infections were classified according to source and drug resistance. Diagnosis based on culture positivity and standard diagnostic criteria. Skin and soft tissue infections diagnosed after meticulous clinical examinations, blood investigations, cultures and ruling out other possible mimics. In view of all the variables are nominal or ordinal, significance calculated as proportions and percentages. RESULTS In present study, common infections were SBP (40%), urinary tract infection (UTI) (28%), skin and soft tissue infections (SSTI) (18%) and lower respiratory infection (LRTI) (12%). Enterobacteriaceae (E. coli and klebsiella) was found to be commonest among all infections followed by enterococcus, streptococcus, staphylococcus and candida. Pseudomonas aeruginosa (second isolate) isolated from patient with SSTI and aeromonas species (second isolate) was isolated from one patient with SBP. Multidrug resistance (MDR) was reported in 44 cases out of 96 total culture positive cases. Approximately about 46% of the study sample reported as MDR. CONCLUSIONS Most common infection found to be SBP followed by UTI, SSTIs and LRTI. Most prevalent organisms were E. coli and klebsiella. Prevalence of SSTI was found to be higher compared to reported literature. Drug resistance especially in klebsiella infections found to be increased compared to available studies. KEY WORDS CLD: Chronic Liver Disease, SBP: Spontaneous Bacterial Peritonitis, UTI: Urinary Tract Infection, LRTI: Lower Respiratory Tract Infection, SSTI: Skin and Soft Tissue Infection, MDR: Multi Drug Resistance.