title: Cirrhotic patients are at risk for health care-associated bacterial infections.
abstract: OBJECTIVE
  Bacterial infections are a frequent and serious burden among patients with cirrhosis because they can further deteriorate liver function. We assessed the epidemiology, risk factors, and clinical consequences of bacterial infections in hospitalized cirrhotic patients.
  
  
  METHODS
  In a cohort of hospitalized cirrhotic patients (n = 150) referred to a tertiary care setting, all episodes of bacterial infections were recorded prospectively. Infections were classified as community-acquired (CA), health care-associated (HCA), or hospital-acquired (HA). Site of infection, characteristics of bacteria, and prevalence of antibiotic resistance were reported; consequences for liver function and patient survival were evaluated.
  
  
  RESULTS
  Fifty-four infections were observed among 50 patients (12 CA, 22 HCA, and 20 HA). Bacterial resistance was more frequent among patients with HCA or HA infections (64% of isolates). Mortality was 37% from HA, 36% from HCA, and 0% from CA infections. Independent predictors of infection included a previous infection within the past 12 months (P = .0001; 95% confidence interval [CI], 2.2-10.6), model of end-stage liver disease score ≥ 5 (P = .01; 95% CI, 1.3-6.1), and protein malnutrition (P = .04; 95% CI, 1.5-10). Infectious episodes worsened liver function in 62% of patients. Patients with infection more frequently developed ascites, hepatic encephalopathy, hyponatremia, hepatorenal syndrome, or septic shock. Child class C (P = .006; 95% CI, 1.67-23.7), sepsis (P = .005; 95% CI, 1.7-21.4), and protein malnutrition (P = .001; 95% CI, 2.8-38.5) increased mortality among patients in the hospital.
  
  
  CONCLUSIONS
  In hospitalized cirrhotic patients, the most frequent infections are HCA and HA; these infections are frequently resistant to antibiotics. As infections worsen, liver function deteriorates and mortality increases. Cirrhotic patients should be monitored closely for infections.
authors.affiliation: Division of Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy. manuela.merli@uniroma1.it
authors.forename: Manuela
authors.initials: M
authors.lastname: Merli
authors.forename: Cristina
authors.initials: C
authors.lastname: Lucidi
authors.forename: Valerio
authors.initials: V
authors.lastname: Giannelli
authors.forename: Michela
authors.initials: M
authors.lastname: Giusto
authors.forename: Oliviero
authors.initials: O
authors.lastname: Riggio
authors.forename: Marco
authors.initials: M
authors.lastname: Falcone
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ridola
authors.forename: Adolfo Francesco
authors.initials: AF
authors.lastname: Attili
authors.forename: Mario
authors.initials: M
authors.lastname: Venditti
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology* / Q000401:mortality; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D016019:Survival Analysis