title: Healthcare-associated and nosocomial bacterial infections in cirrhosis: predictors and impact on outcome.
abstract: OBJECTIVE
  Population-based data on the occurrence of healthcare-associated (HCA) and hospital-acquired (HA) bacterial infections in cirrhosis, their predictors, and their impact on outcome are limited.
  
  
  METHODS
  All patients with incident cirrhosis in 2001-2010 residing in an area of 600,000 inhabitants were retrospectively identified. All serious bacterial infections (resulting in or occurring during an inpatient hospital episode) during this period were registered. Acquisition type, site of infection, occurrence of infection-related acute-on-chronic liver failure (ACLF), acute kidney injury (AKI) and bacterial resistance were analysed. Patients were followed longitudinally until death, transplant or end of 2011.
  
  
  RESULTS
  A total of 398 serious infections occurred in 241/633 (38%) patients. Forty-seven per cent were HCA and 21% HA. Proton pump inhibitor (PPI) use was more common in HA (80%) vs. HCA (64%) vs. community-acquired (44%) infections (P < 0.001). In regression analysis, decompensated status, use of antibiotics and PPIs at infection diagnosis were independent predictors of HCA/HA infections (P < 0.05). After adjustment for confounders, HCA/HA infections were significantly related to infection-related ACLF (P < 0.05), but not severe sepsis, AKI or infection-related mortality (P > 0.05). Antibiotic-resistant infections were more frequent among HA (17%) than HCA (6%) or community-acquired (8%) infections (P < 0.05). Antibiotic-resistant HCA/HA infections were independently related to severe sepsis (P < 0.05).
  
  
  CONCLUSIONS
  In a population-based cirrhotic cohort, two-thirds of serious bacterial infections were HCA or HA. Decompensated liver disease, antibiotics and PPIs were predictors of serious HCA/HA infections, which were associated with the development of ACLF. Antibiotic resistance was frequent, especially in HA infections, and contributed to risk of severe sepsis.
authors.affiliation: Department of Gastroenterology, Skåne University Hospital, University of Lund, Lund, Sweden.
authors.forename: Konstantina
authors.initials: K
authors.lastname: Sargenti
authors.forename: Hanne
authors.initials: H
authors.lastname: Prytz
authors.forename: Anna
authors.initials: A
authors.lastname: Strand
authors.forename: Emma
authors.initials: E
authors.lastname: Nilsson
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D003428:Cross Infection / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D008137:Longitudinal Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012044:Regression Analysis; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors
keywords: acute-on-chronic liver failure; bacterial infections; bacterial resistance; cirrhosis; healthcare-associated infection; hospital-acquired infection; outcome; proton pump inhibitors