Retrospective study of the incidence, risk factors, treatment outcomes of bacterial infections at uncommon sites in cirrhotic patients

Abstract

BACKGROUND

Bacterial infections (BI) negatively affect the natural course of cirrhosis. The most frequent BI are urinary tract infections (UTI), pneumonia, and spontaneous-bacterial peritonitis (SBP).

AIM

To assess the relevance of bacterial infections beyond the commonly recognized types in patients with cirrhosis and to investigate their relationship with other clinical variables.

METHODS

We retrospectively analyzed patients with cirrhosis and BI treated between 2015 and 2018 at our tertiary care center. BIs were classified as typical and atypical, and clinical as well as laboratory parameters were compared between the two groups.

RESULTS

In a cohort of 488 patients with cirrhosis, we identified 225 typical BI (95 UTI, 73 SBP, 72 pulmonary infections) and 74 atypical BIs, predominantly cholangitis and soft tissue infections (21 each), followed by intra-abdominal BIs (n = 9), cholecystitis (n = 6), head/throat BIs (n = 6), osteoarticular BIs (n = 5), and endocarditis (n = 3). We did not observe differences concerning age, sex, or etiology of cirrhosis in patients with typical vs atypical BI. Atypical BIs were more common in patients with more advanced cirrhosis, as evidenced by Model of End Stage Liver Disease (15.1 ± 7.4 vs 12.9 ± 5.1; P = 0.005) and Child-Pugh scores (8.6 ± 2.5 vs 8.0 ± 2; P = 0.05).

CONCLUSION

Atypical BIs in cirrhosis patients exhibit a distinct spectrum and are associated with more advanced stages of the disease. Hence, the work-up of cirrhosis patients with suspected BI requires detailed work-up to elucidate whether typical BI can be identified.

Keywords: Bacterial infection; Empirical antibiotic therapy; End-stage liver disease; Escherichia coli; Multi-resistant pathogens

Core Tip: Bacterial infections (BI) affect the natural course of liver cirrhosis and can trigger decompensation or death. The most frequent BI in cirrhosis (urinary tract infections, pneumonia or spontaneous-bacterial peritonitis) were retrospectively compared to infections at other body sites, which are thought to be less frequently affected (so-called “atypical BI”). When comparing typical/atypical BI, no differences in age, sex, or etiology of cirrhosis were found. Notably, for atypical BI, the stage of cirrhosis was less advanced, as expressed by laboratory parameters and clinical scores (e.g. Model of End Stage Liver Disease - and Child-Pugh-Score).