Retrospective Study
Copyright ©The Author(s) 2024.
World J Hepatol. Mar 27, 2024; 16(3): 418-427
Published online Mar 27, 2024. doi: 10.4254/wjh.v16.i3.418
Table 1 Comparing common and non-common bacterial infections

Atypical BI (n = 74)
Common BI (n = 225)
No BI
(n = 640)
P value1
P value2
P value3
Sex (female)20 (27.0)80 (35.6)218 (34.1)0.200.2430.88
Age (yr)61.14 ± 12.6161.34 ± 11.9560.45 ± 10.760.9010.61
Diabetes (yes)28 (37.8)69 (30.7)199 (31.1)0.260.2380.706
Etiology of cirrhosis
Alcoholic35 (47.3)147 (65.3)317 (49.5)
Hepatitis C2 (2.7)29 (12.9)101 (15.8)
Hepatitis B1 (1.4)3 (1.3)21 (3.3)
NASH5 (6.8)7 (3.1)60 (9.4)
Cryptogenic6 (8.1)19 (8.4)72 (11.3)
PSC7 (9.5)2 (0.9)6 (0.9)
Others11 (14.9)10 (4.4)48 (7.5)
Hemochromatosis3 (4.1)1 (0.4)10 (1.6)
PBC4 (5.4)2 (0.9)5 (0.8)
Medication
Beta blocker33 (45.8)115 (51.8)297 (47.1)0.420.9010.359
Long term ATBx13 (18.1)74 (33.1)73 (11.6)0.0170.128< 0.001
Lactulose24 (33.3)108 (48.6)196 (31.1)0.0290.689< 0.001
PPI49 (68.1)183 (82.4)419 (66.3)0.0130.794< 0.001
Laboratory parameters
Serum sodium (mmol/L)137.62 ± 4.04136.56 ± 5.03138.10 ± 4.610.100.346< 0.001
Creatinine (mg/dL)1.14 ± 0.601.38 ± 1.171.029 ± 0.520.0180.106< 0.001
Total bilirubin (mg/dL)2.83 ± 4.003.73 ± 5.882.21 ± 3.960.140.205< 0.001
Albumin (g/dL)33.24 ± 6.7332.95 ± 6.9136.64 ± 7.140.75< 0.001< 0.001
Hemoglobin (g/dL)11.98 ± 2.2111.19 ± 2.3412.66 ± 2.480.0090.025< 0.001
INR1.27 ± 0.341.37 ± 581.25 ± 0.320.150.6390.001
ASAT108.69 ± 257.7680.55 ± 104.8984.75 ± 185.150.310.4750.930
ALAT71.46 ± 219.9253.63 ± 121.4369.08 ± 164.110.390.9110.327
Platelets164.93 ± 110.00150.74 ± 88.46150.27 ± 79.270.260.1510.527
MELD12.86 ± 5.1315.10 ± 7.4411.60 ± 5.130.0050.049< 0.001
CPS7.99 ± 2.158.61 ± 2.507.19 ± 5.440.050.003< 0.001
Fibroscan (kPa)41.96 ± 21.9446 ± 21.9037.06 ± 21.440.220.106< 0.001
Table 2 Characteristics of patients with atypical bacterial infection (at the time of bacterial infection diagnosis)

Atypical BI (n = 74)
Outcome
Dead within 30 d7 (9.5)
Sepsis9 (12.7)
Laboratory parameters (at BI)
Serum sodium (mmol/L)137 ± 5.5
Creatinine (mg/dL)1.13 ± 13.5
Total bilirubin (mg/dL)1.9 ± 6.67
Albumin (g/dL)30.0 ± 6.25
Hemoglobin (g/dL)11.8 ± 3.00
INR1.20 ± 0.48
ASAT (U/l)67.0 ± 42.47
ALAT (U/l)44 ± 30.92
Platelets154 ± 103
MELD14.5 ± 6.23
CPS8 ± 1.86
WBC (×109)8.2 ± 5.05
CRP (mg/dL)43.1 ± 61.77
Table 3 Microbiological characteristics of selected infections
Pathogen
Organs frequently affected (n)
% MDR1
Gram positive (n = 17)
Staphylococcus aureus (n = 10)Soft tissue infection[3], abscess[3], discitis/osteomyelitis[2], endocarditis[2]1/10
Streptococcus spp. (n = 4)Cholangitis/cholecystitis[1], endocarditis[1], meningitis[1], epididymitis[1]NU
Enterococcus faecium (n = 3)Cholangitis/cholecystitis[3]NA
Gram negative (n = 20)
Escherichia coli (n = 7)Cholangitis[5], soft tissue infection[2]6/7
Klebsiella spp. (n = 3)Cholangitis[1], soft tissue infection[1], appendicitis[1]1/3
Enterobacter spp. (n = 2)Cholangitis[1], periprothetic infection of hip joint[1]1/2
Pseudomonas spp. (n = 4)Soft tissue infection[2], cholangitis[1], abscess[1]0/4
Campylobacter spp. (n = 3)Colitis[3]0/3
Acinetobacter baumanii (n = 1)Soft tissue infection[1]0/1
Table 4 Characteristics of antibiotic therapy
Variable
Number (n = 73)1
Empirical antibiotic treatment
Monotherapy40 (54.8)
Combination therapy with > 2 antibiotics (n)24 (32.9)
Combination therapy with > 3 antibiotics (n)6 (8.2)
Unspecific antibiotic information3 (4,1)
Antibiotic classes1
Penicillins25 (34.2)
Cephalosporins14 (19.2)
Metronidazole14 (19.2)
Carbapenems13 (17.8)
Other13 (17.8)
Quinolones11 (15.1)
Glycopeptides6 (8,2)
Not assessable4 (5.5)
Most frequent antibiotic combinations
Cephalosporins with Metronidazole8 (11)
Carbapenems with others4 (5.5)
Quinolones with Metronidazole3 (4.1)
Coverage
Gram positive26 (35.6)
Gram negative17 (23.3)
Gram positive and negative12 (16.4)
Gram negative and anaerobic12 (16.4)
Non-rankable/gram positive. Negative and anaerobic6 (8.2)
Duration of therapy
One week18 (24.7)
Up to two weeks28 (38.4)
More than two weeks10 (13.7)
No data18 (24.7)
Efficacy of empirical antibiotic therapy
No sufficient data17 (23.3)
No resistance to antibiotics being used19 (26)
Change in multi-resistant germ under antibiotic therapy2 (2.7)
Antibiotic therapy not adequate7 (9.6)
No germ detection with adequate diagnostics. Effectiveness of antibiotic therapy cannot be assessed5 (6.8)
No germ detection in the absence of microbiological diagnostics24 (32.9)