Singh Kunwar A, Anandan Shalini, Sharma Anand, Kumar Santhosh E, Solaimalai Dhanalakshmi, Veeraraghavan Balaji, Goel Ashish, Eapen Chundamannil E, Zachariah Uday G
Departments of Hepatology, Christian Medical College, Vellore, India.
Departments of Microbiology, Christian Medical College, Vellore, India.
J Clin Exp Hepatol. 2024 May-Jun;14(3):101346. doi: 10.1016/j.jceh.2024.101346. Epub 2024 Jan 17.
Data on non-O1/non-O139 (NOVC) infection in liver disease is limited. We studied the clinical features and outcome of patients with cirrhosis with non-NOVC bacteraemia and/or spontaneous bacterial peritonitis (SBP) when compared to non-extended spectrum beta lactamase (non-ESBL) ().
Hospital information system of patients with cirrhosis admitted with bacteraemia and/or SBP from 2010 to 2020 was searched to include patients with NOVC infection. Non-ESBL bacteraemia/bacterascites were chosen as a comparator group, matched for the date of admission within 5 days of index case. Propensity score matching (PSM) was done for patient's age and Child score to compare outcome at discharge between NOVC-infected and -infected cirrhotic patients.
There were 2545 patients admitted with bacteraemia and/or SBP during the study period; 29 had NOVC isolated (M:F = 23:6; age: 39, 18-54 years; median, range; model for end-stage liver disease [MELD] score: 25, 12-38; Child score: 11, 10-12.5) from either blood (26), ascites (3), or both (8). Of these, 26 isolates were pan-sensitive to antibiotic sensitivity tests. Fifty-three patients with non-ESBL were isolated (M: F = 43:10; age: 48; 18-69 years; MELD score: 25, 20-32; Child score:12,11-13) from blood (31), ascites (17), or both (5) within the selected time frame. Of these, 48 isolates were sensitive to the empirical antibiotics initiated.After PSM, in comparison with 29 non-ESBL patients (age: 41, 18-55 years; MELD score: 24, 19-31; Child score: 12, 11-13), NOVC patients had higher incidence of circulatory failure at admission (14 [49 %] vs 4 [13 %]; : 0.01) and significantly higher in-hospital mortality (15 [52 %] vs 6 [20 %];: 0.028].
Bacteraemia due to non-O1/non-O139 strains of , is an uncommon cause of bacteraemia or bacterascites in patients with cirrhosis and is associated with high incidence of circulatory failure and significant mortality.
关于肝病患者非O1/非O139（NOVC）感染的数据有限。我们研究了与非超广谱β-内酰胺酶（non-ESBL）感染相比，肝硬化合并非NOVC菌血症和/或自发性细菌性腹膜炎（SBP）患者的临床特征和预后。
检索2010年至2020年因菌血症和/或SBP入院的肝硬化患者的医院信息系统，纳入NOVC感染患者。选择非ESBL菌血症/菌腹水患者作为对照组，在索引病例的5天内按入院日期进行匹配。对患者年龄和Child评分进行倾向得分匹配（PSM），以比较NOVC感染和未感染的肝硬化患者出院时的预后。
研究期间有2545例因菌血症和/或SBP入院的患者；29例分离出NOVC（男:女 = 23:6；年龄：39岁，18 - 54岁；中位数，范围；终末期肝病模型[MELD]评分：25，12 - 38；Child评分：11，10 - 12.5），分离部位为血液（26例）、腹水（3例）或两者（8例）。其中，26株分离菌对抗生素敏感性试验呈全敏感。在选定时间范围内，从血液（31例）、腹水（17例）或两者（5例）中分离出53例非ESBL感染患者（男:女 = 43:10；年龄：48岁，18 - 69岁；MELD评分：25，20 - 32；Child评分：12，11 - 13）。其中，48株分离菌对初始经验性抗生素敏感。PSM后，与29例非ESBL感染患者（年龄：41岁，18 - 55岁；MELD评分：24，19 - 31；Child评分：12，11 - 13）相比，NOVC感染患者入院时循环衰竭的发生率更高（14例[49%]对4例[13%]；P = 0.01），院内死亡率显著更高（15例[52%]对6例[20%]；P = 0.028）。
非O1/非O139菌株引起的菌血症是肝硬化患者菌血症或菌腹水的罕见原因，与循环衰竭的高发生率和显著死亡率相关。
