Lingiah Vivek A, Pyrsopoulos Nikolaos T
Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
J Clin Transl Hepatol. 2021 Feb 28;9(1):32-39. doi: 10.14218/JCTH.2020.00076. Epub 2020 Dec 22.
Patients with cirrhosis are immunocompromised and at higher risk of developing infections compared to the general population. The aim of this study was to assess the incidence of infections in cirrhotic patients in a large academic liver center and investigate potential associations between infections, bacteria isolated, therapeutic regimens used, and mortality.
This was a retrospective chart review study, including 192 patients. All patients had a diagnosis of cirrhosis and were admitted to University Hospital. Information collected included demographics, etiology of cirrhosis, identification of bacteria from cultures, multidrug-resistant (MDR) status, antibiotics administered, intensive care unit (ICU) admission, and patient mortality.
Infections were present in 105 (54.6%) patients, and 60 (31.2%) patients had multiple infections during a hospitalization(s) for infections. A total of 201 infections were identified. Urinary tract infections (UTIs) were the most common infection (37.8%), followed by bacteremia (20.4%), pneumonia (12.9%), spontaneous bacterial peritonitis (SBP) (11.9%), abscess/cellulitis (6.0%), infectious diarrhea (6.0%), and other (5.0%). was the most common bacteria isolated (13.4%), both among sensitive and MDR infections. MDR bacteria were the cause for 41.3% of all infections isolated. Fungi accounted for 9.5% of infections. 21.9% of patients had decompensation from their infection(s) that required ICU care, and 14.6% of patients died during hospitalization or soon after discharge.
The incidence of infections in cirrhotic patients is much higher than in their non-cirrhotic counterparts (54.6%), even higher than prior studies suggest. As many of these infections are caused by MDR bacteria and fungal organisms, stronger empiric antibiotics and antifungals should be considered when initially treating this immunocompromised population. However, once organism sensitivities are discovered, narrowing of antibiotic regimens must occur to maintain good antibiotic stewardship.
肝硬化患者免疫功能低下，与普通人群相比，发生感染的风险更高。本研究旨在评估一家大型学术性肝脏中心肝硬化患者的感染发生率，并调查感染、分离出的细菌、使用的治疗方案与死亡率之间的潜在关联。
这是一项回顾性病历审查研究，纳入192例患者。所有患者均诊断为肝硬化，并入住大学医院。收集的信息包括人口统计学资料、肝硬化病因、培养物中细菌的鉴定、多重耐药（MDR）状态、使用的抗生素、重症监护病房（ICU）入院情况以及患者死亡率。
105例（54.6%）患者发生感染，60例（31.2%）患者在因感染住院期间发生多种感染。共识别出201次感染。尿路感染（UTI）是最常见的感染（37.8%），其次是菌血症（20.4%）、肺炎（12.9%）、自发性细菌性腹膜炎（SBP）（11.9%）、脓肿/蜂窝织炎（6.0%）、感染性腹泻（6.0%）和其他（5.0%）。 是分离出的最常见细菌（13.4%），在敏感感染和MDR感染中均如此。MDR细菌是所有分离出的感染的41.3%的病因。真菌占感染的9.5%。21.9%的患者因感染出现失代偿，需要ICU护理，14.6%的患者在住院期间或出院后不久死亡。
肝硬化患者的感染发生率远高于非肝硬化患者（54.6%），甚至高于先前研究表明的水平。由于这些感染许多是由MDR细菌和真菌引起的，在最初治疗这一免疫功能低下人群时应考虑使用更强的经验性抗生素和抗真菌药物。然而，一旦发现病原体敏感性，必须缩小抗生素治疗方案以维持良好的抗生素管理。
