P-104 IMPACT OF BACTERIAL INFECTIONS IN THE CLINICAL COURSE OF CIRRHOTIC PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

• Main Authors: Rac D'Oliveira, L. Codes, C.C. Zollinger, M.S. Rocha, P.L. Bittencourt
• Format: Article
• Language: English
• Published: Elsevier 2021-09-01
• Series: Annals of Hepatology
• Online Access: http://www.sciencedirect.com/science/article/pii/S1665268121001630

Introduction: Bacterial infections (BI) occur in 43%-59% of cirrhotic patients (CP) admitted to intensive care units (ICU) and are associated with higher morbidity, mortality, and frequency of multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacteria. Objectives: To describe the characteristics of community-acquired (CA), healthcare-associated (HCA) and hospital-acquired (HA) infections in CP admitted to the ICU; to assess the frequency of acute kidney injury (AKI), hepatorenal syndrome (HRS), acute-on-chronic liver failure (ACLF), sepsis and mortality in CP with BI; and to evaluate the variables predictive of hospital mortality. Methods: Retrospective assessment of all infection episodes occurred in CP admitted in an ICU between January 2012 and June 2018. BI were categorized as CA, HCA and HA. Characteristics of infections and their impact on hospital morbidity and mortality were evaluated. Results: 374 BI were observed in 285 hospitalizations (203 patients,147 males, 67±11 years, Child-Pugh 11±2 and MELD 23±8). Infections were classified as CA (n = 81, 29%), HA (n = 129, 45%) and HA (n = 75, 26%). Gram-negative bacteria occurred in 73% of the isolates, mainly Klebsiella pneumoniae (31%). Spontaneous bacterial peritonitis (32%) was the most common infection. MDR and XDR bacteria occurred in 35% and 16% of hospitalizations. HCA and HA had a higher frequency of MDR bacteria (31% and 41% respectively vs. 20% in CA, p <0,05) and XDR (19% and 17% respectively vs. 6% in CA, p=0,20). The frequency of sepsis was superior in HA in relation to CA (59 vs. 27% and 16%, respectively, p <0.01). The mortality was superior in HA (52% vs. 25% in HCA and 19% in CA, p <0.001). HA (OR 3.48) and HCA (OR 2.25) were independent variables associated with hospital mortality. Conclusions: Knowing the local epidemiology of BI is important because of the impact on the morbidity and mortality of CP. HCA and HA had a higher frequency of MDR and XDR bacteria and death.