Hospital Português da Bahia, Unidade de Gastroenterologia e Hepatologia, Salvador, BA, Brasil.
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
Arq Gastroenterol. 2022 Jan-Mar;59(1):102-109. doi: 10.1590/S0004-2803.202200001-18.
Bacterial infections occur in 43-59% of cirrhotic patients admitted to the intensive care unit with impact in morbidity and mortality. An increase in the frequency of multidrug-resistant (MDRO) and extensively drug-resistant (XDRO) organisms has been described in bacterial infections in cirrhotic patients with an adverse impact on survival.
To characterize community-acquired (CA), healthcare-associated (HCA), and hospital-acquired (HA) infections in cirrhotic patients and their impact in the occurrence of adverse outcomes.
This study included all cirrhotic patients admitted in an intensive care unit specialized in liver and gastrointestinal diseases in Brazil between January 2012 and June 2018. Frequency and topography of infections were retrospectively evaluated, as well as the frequency of MDRO and XDRO organisms, and their impact in occurrence of acute kidney injury, hepatorenal syndrome, acute-on-chronic liver failure, sepsis and mortality.
A total of 374 infections were observed and classified as CA (22%), HCA (34%) and hospital-acquired (44%). Eighty-nine (54%) episodes of hospital-acquired infections were second infections. Spontaneous bacterial peritonitis (32%) and urinary tract infection (23%) were the most common infections. Culture-proven infections were positive in 61% of the cases, mainly gram-negative bacteria (73%). Acute kidney injury, hepatorenal syndrome and sepsis were observed, respectively, in 48%, 15% and 53% of the cases. MDRO and XDRO were seen, respectively, in 35% and 16%, mainly in HCA (48% vs 26% in CA infections, P=0.02) and hospital-acquired (58% vs 26% in CA infections, P=0.0009). Adverse outcomes were more frequently observed in subjects with hospital-acquired infections when compared to HCA and CA infections. Hospital-acquired, HCA and second infections were independently associated with in-hospital mortality.
Hospital-acquired, HCA and second infections are increasingly associated with either MDRO and/or XDRO and are independent predictors of in-hospital mortality. Their recognition and proper selection of appropriate empiric antibiotic regimens are important measures to reduce in-hospital mortality.
在入住重症监护病房的肝硬化患者中，有 43%-59%发生细菌感染，这对发病率和死亡率都有影响。在肝硬化患者的细菌感染中，已经描述了多重耐药（MDRO）和广泛耐药（XDRO）病原体的频率增加，这对生存率有不利影响。
描述肝硬化患者的社区获得性（CA）、医疗保健相关性（HCA）和医院获得性（HA）感染及其对不良结局的影响。
本研究纳入了 2012 年 1 月至 2018 年 6 月期间在巴西一家专门治疗肝脏和胃肠道疾病的重症监护病房入住的所有肝硬化患者。回顾性评估感染的频率和部位，以及 MDRO 和 XDRO 病原体的频率，及其对急性肾损伤、肝肾综合征、慢加急性肝衰竭、脓毒症和死亡率的影响。
共观察到 374 例感染，分为 CA（22%）、HCA（34%）和 HA（44%）。89 例（54%）HA 感染为二次感染。自发性细菌性腹膜炎（32%）和尿路感染（23%）是最常见的感染。有培养结果的感染占 61%，主要为革兰氏阴性菌（73%）。分别有 48%、15%和 53%的患者发生急性肾损伤、肝肾综合征和脓毒症。MDRO 和 XDRO 的检出率分别为 35%和 16%，主要见于 HCA（48% vs CA 感染的 26%，P=0.02）和 HA（58% vs CA 感染的 26%，P=0.0009）。与 HCA 和 CA 感染相比，HA 感染患者的不良结局更为常见。HA、HCA 和二次感染与 MDRO 和/或 XDRO 相关，是院内死亡的独立预测因素。认识到这些感染并适当选择经验性抗生素方案是降低院内死亡率的重要措施。
