Bacterial Infections in Cirrhotic Patients in a Tertiary Care Hospital

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Background and Aims: Patients with cirrhosis are immu-nocompromised 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, thera-peutic regimens used, and mortality. Methods: 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 demo-graphics, etiology of cirrhosis, identification of bacteria from cultures, multidrug-resistant (MDR) status, antibiotics ad-ministered, intensive care unit (ICU) admission, and patient mortality. Results: 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 in-fections were identified. Urinary tract infections (UTIs) were the most common infection (37.8%), followed by bactere-mia (20.4%), pneumonia (12.9%), spontaneous bacterial peritonitis (SBP) (11.9%), abscess/cellulitis (6.0%), infec-tious diarrhea (6.0%), and other (5.0%). Escherichia coli 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 decompen-sation from their infection(s) that required ICU care, and 14.6% of patients died during hospitalization or soon after discharge. Conclusions: The incidence of infections in cir-rhotic patients is much higher than in their non-cirrhotic counterparts (54.6%), even higher than prior studies sug-gest. As many of these infections are caused by MDR bac-teria and fungal organisms, stronger empiric antibiotics and antifungals should be considered when initially treating thisimmunocompromised population. However, once organism sensitivities are discovered, narrowing of antibiotic regi-mens must occur to maintain good antibiotic stewardship.
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