Epidemiology of bacterial infections in patients with liver cirrhosis. Experience in a Spanish tertiary health center.
BACKGROUND
Bacterial infections represent a serious complication of liver cirrhosis. Traditionally, Gram negative bacteria have been described as the microorganisms responsible for the majority of the infections. However, in the past few years, changes in the microbiological spectrum have been described, and multiresistant bacteria are observed more frequently.


OBJECTIVE
To assess the proportion of patients with infections caused by multiresistant bacteria admitted to our hospital, and to obtain information about their epidemiology, risk factors and clinical impact.


METHODS
We performed a retrospective evaluation of 294 cirrhotic patients admitted to our unit due to infection between June, 2011, and June, 2013.


RESULTS
We isolated 310 microorganisms from 294 patients; 109 (35.2%) were Gram positive, 167 (53.9%), Gram negative, and 34, fungi (11%). As for the microbiological agents, the most frequent was Escherichia coli (98 isolations). The infection was community-acquired in 22.9% of cases, healthcareassociated in 38.1% and nosocomial in 39%. Worse liver infections and septic shock were more frequent among patients with multiresistant isolates (p=0.05); and intrahospital mortality was also higher among them (p=0.017). Previous hospital admission, antibiotic treatment 60 days before, nosocomial or healthcare-associated acquisition and bacterial isolation in control cultures were identified as possible risk factors for the development of multiresistant infection.


CONCLUSIONS
The results of our study confirm that important changes have ocurred in the microbiological spectrum of bacterial infections in patients with liver cirrhosis. Multiresistant bacteria are associated with high morbidity and mortality, as well as failure of traditional antibiotic treatment. Successfull control of the infection requires an early identification of patients at risk.
Servicio Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España. katerina_klimova@yahoo.com.
Katerina
K
Klímová
Camilo
C
Padilla
Juan Carlos
JC
Ávila
Gerardo
G
Clemente
Alejandra
A
Ochoa
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004198:Disease Susceptibility; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D019698:Hepatitis C, Chronic / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology*; D008104:Liver Cirrhosis, Alcoholic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
D000900:Anti-Bacterial Agents
Bacterial infections/epidemiology; anti-bacterial agents; bacterial; drug resistance; liver cirrhosis; multiple; risk factors