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©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
Published online Mar 27, 2024. doi: 10.4254/wjh.v16.i3.418
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) | 0.20 | 0.243 | 0.88 |
Age (yr) | 61.14 ± 12.61 | 61.34 ± 11.95 | 60.45 ± 10.76 | 0.901 | 0.61 | |
Diabetes (yes) | 28 (37.8) | 69 (30.7) | 199 (31.1) | 0.26 | 0.238 | 0.706 |
Etiology of cirrhosis | ||||||
Alcoholic | 35 (47.3) | 147 (65.3) | 317 (49.5) | |||
Hepatitis C | 2 (2.7) | 29 (12.9) | 101 (15.8) | |||
Hepatitis B | 1 (1.4) | 3 (1.3) | 21 (3.3) | |||
NASH | 5 (6.8) | 7 (3.1) | 60 (9.4) | |||
Cryptogenic | 6 (8.1) | 19 (8.4) | 72 (11.3) | |||
PSC | 7 (9.5) | 2 (0.9) | 6 (0.9) | |||
Others | 11 (14.9) | 10 (4.4) | 48 (7.5) | |||
Hemochromatosis | 3 (4.1) | 1 (0.4) | 10 (1.6) | |||
PBC | 4 (5.4) | 2 (0.9) | 5 (0.8) | |||
Medication | ||||||
Beta blocker | 33 (45.8) | 115 (51.8) | 297 (47.1) | 0.42 | 0.901 | 0.359 |
Long term ATBx | 13 (18.1) | 74 (33.1) | 73 (11.6) | 0.017 | 0.128 | < 0.001 |
Lactulose | 24 (33.3) | 108 (48.6) | 196 (31.1) | 0.029 | 0.689 | < 0.001 |
PPI | 49 (68.1) | 183 (82.4) | 419 (66.3) | 0.013 | 0.794 | < 0.001 |
Laboratory parameters | ||||||
Serum sodium (mmol/L) | 137.62 ± 4.04 | 136.56 ± 5.03 | 138.10 ± 4.61 | 0.10 | 0.346 | < 0.001 |
Creatinine (mg/dL) | 1.14 ± 0.60 | 1.38 ± 1.17 | 1.029 ± 0.52 | 0.018 | 0.106 | < 0.001 |
Total bilirubin (mg/dL) | 2.83 ± 4.00 | 3.73 ± 5.88 | 2.21 ± 3.96 | 0.14 | 0.205 | < 0.001 |
Albumin (g/dL) | 33.24 ± 6.73 | 32.95 ± 6.91 | 36.64 ± 7.14 | 0.75 | < 0.001 | < 0.001 |
Hemoglobin (g/dL) | 11.98 ± 2.21 | 11.19 ± 2.34 | 12.66 ± 2.48 | 0.009 | 0.025 | < 0.001 |
INR | 1.27 ± 0.34 | 1.37 ± 58 | 1.25 ± 0.32 | 0.15 | 0.639 | 0.001 |
ASAT | 108.69 ± 257.76 | 80.55 ± 104.89 | 84.75 ± 185.15 | 0.31 | 0.475 | 0.930 |
ALAT | 71.46 ± 219.92 | 53.63 ± 121.43 | 69.08 ± 164.11 | 0.39 | 0.911 | 0.327 |
Platelets | 164.93 ± 110.00 | 150.74 ± 88.46 | 150.27 ± 79.27 | 0.26 | 0.151 | 0.527 |
MELD | 12.86 ± 5.13 | 15.10 ± 7.44 | 11.60 ± 5.13 | 0.005 | 0.049 | < 0.001 |
CPS | 7.99 ± 2.15 | 8.61 ± 2.50 | 7.19 ± 5.44 | 0.05 | 0.003 | < 0.001 |
Fibroscan (kPa) | 41.96 ± 21.94 | 46 ± 21.90 | 37.06 ± 21.44 | 0.22 | 0.106 | < 0.001 |
Atypical BI (n = 74) | |
Outcome | |
Dead within 30 d | 7 (9.5) |
Sepsis | 9 (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 |
INR | 1.20 ± 0.48 |
ASAT (U/l) | 67.0 ± 42.47 |
ALAT (U/l) | 44 ± 30.92 |
Platelets | 154 ± 103 |
MELD | 14.5 ± 6.23 |
CPS | 8 ± 1.86 |
WBC (×109) | 8.2 ± 5.05 |
CRP (mg/dL) | 43.1 ± 61.77 |
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 |
Variable | Number (n = 73)1 |
Empirical antibiotic treatment | |
Monotherapy | 40 (54.8) |
Combination therapy with > 2 antibiotics (n) | 24 (32.9) |
Combination therapy with > 3 antibiotics (n) | 6 (8.2) |
Unspecific antibiotic information | 3 (4,1) |
Antibiotic classes1 | |
Penicillins | 25 (34.2) |
Cephalosporins | 14 (19.2) |
Metronidazole | 14 (19.2) |
Carbapenems | 13 (17.8) |
Other | 13 (17.8) |
Quinolones | 11 (15.1) |
Glycopeptides | 6 (8,2) |
Not assessable | 4 (5.5) |
Most frequent antibiotic combinations | |
Cephalosporins with Metronidazole | 8 (11) |
Carbapenems with others | 4 (5.5) |
Quinolones with Metronidazole | 3 (4.1) |
Coverage | |
Gram positive | 26 (35.6) |
Gram negative | 17 (23.3) |
Gram positive and negative | 12 (16.4) |
Gram negative and anaerobic | 12 (16.4) |
Non-rankable/gram positive. Negative and anaerobic | 6 (8.2) |
Duration of therapy | |
One week | 18 (24.7) |
Up to two weeks | 28 (38.4) |
More than two weeks | 10 (13.7) |
No data | 18 (24.7) |
Efficacy of empirical antibiotic therapy | |
No sufficient data | 17 (23.3) |
No resistance to antibiotics being used | 19 (26) |
Change in multi-resistant germ under antibiotic therapy | 2 (2.7) |
Antibiotic therapy not adequate | 7 (9.6) |
No germ detection with adequate diagnostics. Effectiveness of antibiotic therapy cannot be assessed | 5 (6.8) |
No germ detection in the absence of microbiological diagnostics | 24 (32.9) |
- Citation: Schneitler S, Schneider C, Casper M, Lammert F, Krawczyk M, Becker SL, Reichert MC. Retrospective study of the incidence, risk factors, treatment outcomes of bacterial infections at uncommon sites in cirrhotic patients. World J Hepatol 2024; 16(3): 418-427
- URL: https://www.wjgnet.com/1948-5182/full/v16/i3/418.htm
- DOI: https://dx.doi.org/10.4254/wjh.v16.i3.418