Bacterial infections in cirrhosis patients: a retrospective epidemiologic study in a greek university hospital

Introduction: Cirrhosis of liver is the end stage of multiple processes that lead to hepatic failure and eventually death. Patients with cirrhosis are immunocompromised and are predisposed to develop bacterial infections, sepsis and severe sepsis. The most common infections in cirrhosis are Spontaneous Bacterial Peritonitis (SBP, 25%-31%) followed by Urinary Tract Infection (UTI, 20%-25%), Pneumonia (15%-21%), Bacteremia (12%) and Cellulitis (11%). The aim of the study was to first identify the most frequent infections in patients with liver cirrhosis and evaluate the role of bacterial infections in clinical outcome of cirrhotic patients. We also tried to identify the most common cause of cirrhosis in our population. Patients and methods: One hundred and ten (110) patients were included in our study. All of these patients had an established diagnosis of chronic liver failure and were admitted to the University hospital of Patras during a period of a year and a half. The following data were collected: Demographic characteristics (Age, Sex), Etiology of cirrhosis and the cause of admission. In specific interest the type of infection that was developed in all patients is included, as well as the frequency of those infections was observed. Results: The mean age of all patients enrolled in our study was 61±13 years. Alcoholic cirrhosis was the main factor-etiology of liver cirrhosis in our patient population. Male are significantly more than female patients (87.3% vs 12.7% retrospectively). In our study, the most frequent infections were Pneumonia (30.6%) and Spontaneous bacterial peritonitis (22.2%) followed by Gastrointestinal infections (GI) (13.9%) and Urinary tract infections (8.3%). Other types of infection were up to 13.9%. During the time of admission, there were 16 cases of bacterial infections diagnosed upon admission (<24 hours) and 5 cases of infections developed during hospitalization (>48 hours). Mortality rate was 9% (10 cases).Ten patients with sepsis or severe sepsis have died. All of them were treated with broad spectrum antibiotics within 24 hours from admission. Conclusion: The present study showed a high incidence of Bacterial infections in patients with liver cirrhosis. Patients with chronic liver disease sustained impairment to their immune system (neutrophil and macrophage dysfunction) which worsens over time and disease progression and the reason predisposed for developing Bacterial infections. A high rate of suspicion is needed for an infectious process in all patients with liver cirrhosis. With early diagnosis of the site of infection and the appropriate antibiotic treatment the morbidity and mortality rate of bacterial infections in cirrhotic patients, can be decreased over the years.