title: Bacterial infections in alcoholic and nonalcoholic liver cirrhosis.
abstract: OBJECTIVE
  Longitudinal, population-based data on the occurrence, localization, and severity of bacterial infections over time in patients with alcoholic compared with nonalcoholic cirrhosis are limited.
  
  
  METHODS
  All patients with incident cirrhosis diagnosed in 2001-2010 (area of 600,000 inhabitants) were retrospectively identified. All bacterial infections resulting in or occurring during an inpatient hospital episode during this period were registered. The etiology of cirrhosis (alcoholic vs. nonalcoholic), infection localization, and outcome as well as bacterial resistance patterns were analyzed. Patients were followed until death, transplant, or the end of 2011.
  
  
  RESULTS
  In all, 633 cirrhotics (363 alcoholic, 270 nonalcoholic) experienced a total of 398 infections (2276 patient-years). Among patients diagnosed with cirrhosis each year from 2001 to 2010, increasing trends were noted in the occurrence of infection (from 13 to 27%, P<0.001) and infection-related in-hospital mortality (from 2 to 7%, P=0.05), the latter mainly in the alcoholic group. Although alcoholic etiology was related to the occurrence of more frequent infection (Kaplan-Meier, P<0.001), this relationship was not significant after adjustment for confounders in Cox regression analysis (P=0.056). Resistance to piperacilin-tazobactam and carbapenems was more common in infections occurring in alcoholic versus nonalcoholic cirrhosis (13 vs. 5%, P=0.057 and 12 vs. 2%, P=0.009). Alcoholic etiology predicted pneumonia and infections caused by Gram-positive bacteria in multivariate analysis (P<0.05 for both).
  
  
  CONCLUSIONS
  In a population-based cirrhotic cohort, bacterial infections increased over time, which, in the case of alcoholic cirrhosis, was associated with pneumonia and bacterial resistance to antibiotics. However, alcoholic etiology was not related indepedently to the occurrence of bacterial infections.
authors.affiliation: aDepartment of Gastroenterology, Skåne University Hospital, University of Lund, Lund, Sweden bDigestive Disease Center, Copenhagen University Hospital/Bispebjerg, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Konstantina
authors.initials: K
authors.lastname: Sargenti
authors.forename: Hanne
authors.initials: H
authors.lastname: Prytz
authors.forename: Emma
authors.initials: E
authors.lastname: Nilsson
authors.forename: Sara
authors.initials: S
authors.lastname: Bertilsson
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008104:Liver Cirrhosis, Alcoholic / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents