Bacteremia in patients with liver cirrhosis in the era of increasing antimicrobial resistance: single-center epidemiology

  • Tamara Milovanovic Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
  • Ivana Pantic Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia https://orcid.org/0000-0003-1137-1141
  • Jelena Velickovic Faculty of Medicine, University of Belgrade, Belgrade, Serbia https://orcid.org/0000-0001-7862-5420
  • Branislav Oluic Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Zeljko Vlaisavljevic Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
  • Sanja Dragasevic Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia https://orcid.org/0000-0003-1944-3883
  • Milica Stojkovic Lalosevic Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia https://orcid.org/0000-0003-4836-4439
  • Igor Dumic Mayo Clinic College of Medicine, Rochester, MN, United States https://orcid.org/0000-0002-5312-8812
Keywords: epidemiology, bacteremia, liver cirrhosis, mortality, multi-drug resistance

Abstract

Introduction: Liver cirrhosis is commonly associated with bacterial infections, which contribute to unfavorable outcome. This study aimed to investigate the epidemiology of bacteremia and patterns of antibiotic resistance in patients with cirrhosis, factors associated with multidrug-resistant infection, and predictors of mortality.

Methodology: This retrospective single-center study included patients with cirrhosis treated between January 2016 and December 2018. Data were collected from the patients’ medical records. The severity of liver disease was determined using the Child–Pugh, Model for End-Stage Liver Disease-Na, Chronic Liver Failure-Consortium Acute-on-Chronic Liver Failure, and Chronic Liver Failure-Consortium Acute Decompensation scores.

Results: A total of 85 patients with cirrhosis and bacteremia were included (male: 82.4%, mean age 60.3 ± 9.4 years). The etiology of cirrhosis was mainly alcoholism (87.1%). After 30 days, lethal outcome occurred in 44.7% of the patients. The most commonly isolated pathogens were Enterococcus spp. (31.8%), methicillin-sensitive Staphylococcus aureus (15.3%), and Escherichia coli (14.1%), while 37.3% of all isolated microorganisms were multi-drug resistant. Multi-drug resistant infection [odds ratio (OR): 6.198, 95% confidence interval (CI): 2.326–17.540, p = 0.006] and neutrophil-to-lymphocyte ratio (OR = 1.181, 95% CI = 1.043–1.337, p = 0.009) are independent predictors of mortality. The aforementioned scores, which represent the extent of hepatic insufficiency, are significantly higher in patients with multi-drug resistant isolates, while multi-drug resistant bacteremia was more common in patients with more advanced liver disease.

Conclusions: Multi-drug resistant bacteremia is more common in patients in whom liver disease is more severe and is a major independent predictor of mortality.

Published
2021-12-31
How to Cite
1.
Milovanovic T, Pantic I, Velickovic J, Oluic B, Vlaisavljevic Z, Dragasevic S, Stojkovic LalosevicM, Dumic I (2021) Bacteremia in patients with liver cirrhosis in the era of increasing antimicrobial resistance: single-center epidemiology. J Infect Dev Ctries 15:1883-1890. doi: 10.3855/jidc.14508
Section
Original Articles