Cirrhotic Patients Are at Risk for Health Care-Associated Bacterial Infections

BACKGROUND & AIMS Bacterial infections are a frequent and serious burden among patients with cirrhosis be cause they can further deteriorate liver function We assessed the epidemiology risk factors, and clinical consequences of bacterial infections in hospitalized cirrhotic patients METHODS In a cohort of hospitalized cirrhotic patients (n = 150) referred the a tertiary cat e setting, all episodes of bacterial infections were recorded prospectively Infections were classified as community acquired (CA), health care-associated (HCA), or hospital acquired (HA) Site of infection, charactetistics of bacteria, and prevalence of antibiotic resistance were reported, consequences for liver function and patient survival were evaluated RESULTS Fifty four infections were observed among 50 patients (12 CA, 22 HCA, and 20 HA) Bacterial resistance was more frequent among patients with HCA or HA infections (64% of isolates) Mortality was 37% from HA, 36% from HCA, and 0% from CA infections Independent predictors of Infection Included a previous infection within the past 12 months (P = 0001, 95% confidence interval [CI], 2 2-10 6), model of end stage liver disease store >= 15 (P = 01, 95% CI, 1 3-6 1), and protein malnutrition (P = 04, 95% CI, 1 5-10) Infectious episodes worsened live, function in 62% of patients Patients with infection more frequently developed ascites, hepatic encephalopathy, hyponatamia, hepatorenal syndrome, or septic shock Child class C (P = 006, 95% CI, 1 67-23 7), sepsis (P = 005, 95% CI, 1 7-21 4) and protein malnutrition (P = 001 95% CI 2 8 38 5) increased mortality among patients in the hospital CONCLUSIONS In hospitalized cirrhotic patients, the most frequent infections are HCA and HA, these infections are frequently resistant to antibiotics As infections worsen, liver function deteriorates and mortality increases Cirrhotic patients should be monitored closely for infections