住院肝硬化患者的感染：流行病学和临床特征的变化

Infection in Hospitalized Cirrhosis Patients: Changing Epidemiology and Clinical Features.

作者信息

Choudry Nida, Sasso Roula, Rockey Don C

机构信息

Division of Gastroenterology and Hepatology, and the Digestive Disease Research Center, Medical University of South Carolina, Charleston, South Carolina.

出版信息

Am J Med Sci. 2022 Feb;363(2):114-121. doi: 10.1016/j.amjms.2021.10.023. Epub 2022 Jan 5.

DOI:10.1016/j.amjms.2021.10.023

PMID:34995572

Abstract

BACKGROUND

Patients with cirrhosis are uniquely predisposed to infections, which can lead to acute decompensation and an increase in mortality rates. We hypothesized that not only are cirrhotic patients more likely to develop certain infections, but that specific infections are associated with poorer outcomes. Therefore, we aimed to examine the epidemiology, bacteriology, and outcomes of infections in cirrhotic patients admitted to the hospital.

METHODS

In this single center observational retrospective cohort study, we identified admissions in which patients had an infection from a group of all admissions of cirrhotics from 2011-2016. Infections were categorized by the primary source of infection, and rigorous clinical and bacteriologic definitions were used.

RESULTS

We identified 1,208 admissions in 877 unique patients during the study period. The most common infections identified were as follows: urinary tract infections (33%), pneumonia (23%), spontaneous bacterial peritonitis (14%), and bacteremia (11%). Gram-positive organisms were most commonly isolated in patients with spontaneous bacterial peritonitis and bacteremia, whereas gram-negative bacteria were most prevalent in urinary tract infections and pneumonia. Candida infections were common and identified in the following proportions: spontaneous bacterial peritonitis (16%), pneumonia (14%), bacteremia (13%), and urinary tract infections (9%). Pneumonia, spontaneous bacterial peritonitis, and meningitis were associated with increased mortality rates (29%, 32%, and 67%, respectively), compared to the overall mortality rate of 20% (p-value < 0.05).

CONCLUSIONS

In summary, infections were common in patients with cirrhosis and were associated with poor outcomes, particularly in the presence of evidence of sepsis. Spontaneous bacterial peritonitis and bacteremia are now most commonly due to gram-positive organisms and fungal infections appear to be rising in prevalence.

摘要

背景

肝硬化患者特别容易发生感染，这可能导致急性失代偿并增加死亡率。我们推测，肝硬化患者不仅更容易发生某些感染，而且特定感染与更差的预后相关。因此，我们旨在研究住院肝硬化患者感染的流行病学、细菌学及预后情况。

方法

在这项单中心观察性回顾性队列研究中，我们从2011年至2016年所有肝硬化患者的入院病例中识别出有感染的患者。感染按主要感染源分类，并采用严格的临床和细菌学定义。

结果

在研究期间，我们在877例独特患者中识别出1208次入院感染病例。最常见的感染类型如下：尿路感染（33%）、肺炎（23%）、自发性细菌性腹膜炎（14%）和菌血症（11%）。革兰氏阳性菌最常分离自自发性细菌性腹膜炎和菌血症患者，而革兰氏阴性菌在尿路感染和肺炎患者中最为普遍。念珠菌感染很常见，其比例如下：自发性细菌性腹膜炎（16%）、肺炎（14%）、菌血症（13%）和尿路感染（9%）。与总体死亡率20%相比，肺炎、自发性细菌性腹膜炎和脑膜炎与死亡率增加相关（分别为29%、32%和67%，p值<0.05）。