title: Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study.
abstract: OBJECTIVE
  To evaluate the prevalence, incidence and clinical relevance of bacterial infection in predominantly non-alcoholic cirrhotic patients hospitalised for decompensation.
  
  
  METHODS
  A total of 405 consecutive admissions in 361 patients (249 males and 112 females; 66 Child-Pugh class B and 295 class C) were analysed. Blood, urine, ascitic and pleural fluid cultures were performed within the first 24 hours, during hospitalisation whenever infection was suspected, and again before discharge.
  
  
  RESULTS
  Over a one year period, 150 (34%) bacterial infections (89 community- and 61 hospital-acquired) involving urinary tract (41%), ascites (23%), blood (21%) and respiratory tract (17%) were diagnosed. The prevalence of bacterial peritonitis was 12%. Infections were asymptomatic in 69 cases (46%) and 130 (87%) involved a single site. Enteric flora accounted for 62% of infections, Escherichia Coli being the most frequent pathogen (25%). Community-acquired infections were associated with more advanced liver disease (Child-Pugh mean score 10.2+/-2.1 versus 9.5+/-1.9, p<0.05), renal failure (p<0.05), and high white blood cell count (p<0.01). Hospital-acquired infections occurred more frequently in patients admitted for gastrointestinal bleeding (p<0.05). The in-hospital mortality was significantly higher in infected than in non-infected patients (15% versus 7%, p<0.05), and infection emerged as an independent variable affecting survival. Moreover bacterial infection accounted for a significantly prolonged hospital stay.
  
  
  CONCLUSIONS
  Bacterial infection, regardless of the aetiology, is a severe complication of decompensated cirrhosis, and, although frequently asymptomatic, accounts for both longer hospital stay and increased mortality.
authors: Department of Medicine, Fatebenefratelli Hospital, Milan, Italy. maborzio@tin.it
authors: M
authors: M
authors: Borzio
authors: F
authors: F
authors: Salerno
authors: L
authors: L
authors: Piantoni
authors: M
authors: M
authors: Cazzaniga
authors: P
authors: P
authors: Angeli
authors: F
authors: F
authors: Bissoli
authors: S
authors: S
authors: Boccia
authors: G
authors: G
authors: Colloredo-Mels
authors: P
authors: P
authors: Corigliano
authors: G
authors: G
authors: Fornaciari
authors: G
authors: G
authors: Marenco
authors: R
authors: R
authors: Pistarà
authors: M
authors: M
authors: Salvagnini
authors: A
authors: A
authors: Sangiovanni
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000276:immunology / Q000401:mortality*; D003428:Cross Infection / Q000276:immunology / Q000401:mortality*; D003430:Cross-Sectional Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000276:immunology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000276:immunology / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors