Gupta Tarana, Lochan Dibya, Verma Nipun, Rathi Sahaj, Agrawal Swastik, Duseja Ajay, Taneja Sunil, Chawla Yogesh K, Dhiman Radha K
Department of Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
J Gastroenterol Hepatol. 2020 Mar;35(3):461-466. doi: 10.1111/jgh.14788. Epub 2019 Aug 29.
The aim of this study is to evaluate the epidemiology and impact of bacterial infections at admission in patients with acute decompensation (AD) of cirrhosis.
A cohort with AD of cirrhosis (European Association for the Study of the Liver criteria) admitted at a tertiary center was evaluated between 2013 and 2014 for the presence of bacterial infections at admission. Clinical, demographic, and microbiological data were collected prospectively till death, transplant, or 90 days.
Of 179 patients with AD, 102 (56.9%) had bacterial infections at admission. The commonest infections were spontaneous bacterial peritonitis (SBP) (n = 65; 63.7%), spontaneous bacteremia (n = 10; 9.8%), pneumonia (n = 9; 8.8%), urinary tract infection (n = 8; 7.8%), spontaneous bacterial empyema (n = 4; 3.9%), and cellulitis (n = 2; 1.9%). The commonest source was community acquired (n = 85; 83.3%). Serum albumin and sodium levels were lower in infected as compared with non-infected cohort (P = 0.015; for both). Escherichia coli was the commonest organism isolated from SBP (n = 14; 21.5%), urinary tract infection (n = 5; 45.5%), and bacteremia (n = 3; 20%). There was a trend toward higher 28-day mortality in infected cohort as compared with non-infected cohort (48 [52.7%] vs 28 [32%]; P = 0.152). Multidrug-resistant organisms (MDROs) were isolated in 63% of all culture-positive infections. The presence of MDRO was an independent predictor of 28-day mortality.
Infections are the leading reason for the occurrence of AD; SBP is the most common infection, and E. coli is the commonest microorganism based on this single-center study of Indian patients with AD of cirrhosis. There is a high prevalence of MDROs among culture-positive infections that independently predict 28-day mortality in AD of cirrhosis.
本研究旨在评估肝硬化急性失代偿（AD）患者入院时细菌感染的流行病学情况及其影响。
对2013年至2014年期间在一家三级中心收治的符合肝硬化AD（欧洲肝脏研究协会标准）的队列患者进行评估，以确定入院时是否存在细菌感染。前瞻性收集临床、人口统计学和微生物学数据，直至患者死亡、接受移植或90天。
179例AD患者中，102例（56.9%）入院时存在细菌感染。最常见的感染是自发性细菌性腹膜炎（SBP）（n = 65；63.7%）、自发性菌血症（n = 10；9.8%）、肺炎（n = 9；8.8%）、尿路感染（n = 8；7.8%）、自发性细菌性脓胸（n = 4；3.9%）和蜂窝织炎（n = 2；1.9%）。最常见的感染源是社区获得性（n = 85；83.3%）。与未感染队列相比，感染队列的血清白蛋白和钠水平较低（两者P = 0.015）。大肠杆菌是从SBP（n = 14；21.5%）、尿路感染（n = 5；45.5%）和菌血症（n = 3；20%）中分离出的最常见病原体。与未感染队列相比，感染队列的28天死亡率有升高趋势（48例[52.7%]对28例[32%]；P = 0.152）。在所有培养阳性感染中，63%分离出多重耐药菌（MDROs）。MDRO的存在是28天死亡率的独立预测因素。
感染是AD发生的主要原因；基于对印度肝硬化AD患者的这项单中心研究，SBP是最常见的感染，大肠杆菌是最常见的微生物。培养阳性感染中MDRO的患病率很高，其独立预测肝硬化AD患者的28天死亡率。
