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Prediction of 28‐day mortality in acute decompensation of cirrhosis through the presence of multidrug‐resistant infections at admission
Author(s) -
Gupta Tarana,
Lochan Dibya,
Verma Nipun,
Rathi Sahaj,
Agrawal Swastik,
Duseja Ajay,
Taneja Sunil,
Chawla Yogesh K,
Dhiman Radha K
Publication year - 2020
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14788
Subject(s) - medicine , spontaneous bacterial peritonitis , bacteremia , cirrhosis , cohort , decompensation , gastroenterology , pneumonia , urinary system , cellulitis , antibiotics , surgery , microbiology and biotechnology , biology
Abstract Background and Aim The aim of this study is to evaluate the epidemiology and impact of bacterial infections at admission in patients with acute decompensation (AD) of cirrhosis. Methods A cohort with AD of cirrhosis (European Association for the Study of the Liver criteria) admitted at a tertiary center was evaluated between 2013 and 2014 for the presence of bacterial infections at admission. Clinical, demographic, and microbiological data were collected prospectively till death, transplant, or 90 days. Results Of 179 patients with AD, 102 (56.9%) had bacterial infections at admission. The commonest infections were spontaneous bacterial peritonitis (SBP) ( n = 65; 63.7%), spontaneous bacteremia ( n = 10; 9.8%), pneumonia ( n = 9; 8.8%), urinary tract infection ( n = 8; 7.8%), spontaneous bacterial empyema ( n = 4; 3.9%), and cellulitis ( n = 2; 1.9%). The commonest source was community acquired ( n = 85; 83.3%). Serum albumin and sodium levels were lower in infected as compared with non‐infected cohort ( P = 0.015; for both). Escherichia coli was the commonest organism isolated from SBP ( n = 14; 21.5%), urinary tract infection ( n = 5; 45.5%), and bacteremia ( n = 3; 20%). There was a trend toward higher 28‐day mortality in infected cohort as compared with non‐infected cohort (48 [52.7%] vs 28 [32%]; P = 0.152). Multidrug‐resistant organisms (MDROs) were isolated in 63% of all culture‐positive infections. The presence of MDRO was an independent predictor of 28‐day mortality. Conclusions Infections are the leading reason for the occurrence of AD; SBP is the most common infection, and E. coli is the commonest microorganism based on this single‐center study of Indian patients with AD of cirrhosis. There is a high prevalence of MDROs among culture‐positive infections that independently predict 28‐day mortality in AD of cirrhosis.