Skin and soft tissue bacterial infections in cirrhotic patients with edema

Abstract

Objective: The aim of this study was to determine the type, risk factors, and the causative organism of bacterial skin infections in cirrhotic patients with edema. Background: Bacterial infections are often associated with significant morbidity and mortality in cirrhosis. The common practice of outdoor barefoot walking and the associated risk of trauma may predispose cirrhotic patients to skin infection. Patients and methods: This study was conducted on 150 patients, of whom 35 cirrhotic patients served as the control group. Data, including the type, the site, risk factors, and the culture results of the skin or soft tissue infection present, were collected. Results: A unique criterion of this study was that in all the study participants in the cirrhotic group the infection was due to posthepatitic cirrhosis (hepatitis C virus, hepatitis B virus, or combined infection). History or evidence of trauma, uncontrolled diabetes, massive lower-limb edema, and a high BMI are major risk factors for developing skin or soft tissue infection. Cellulitis represents the most common type of infection, affecting mainly the lower limbs. Gram-negative organisms are the causative organisms in cirrhotic patients (17%), mainly Escherichia coli in 13% of the cases. Conclusion: Gram-negative bacteria may cause bullous cellulitis in patients with cirrhosis. Trauma, diabetes mellitus, and massive lower-limb edema are major risk factors for skin and soft tissue infections in cirrhotic patients.