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[Prevalence and risk factors for bacteriuria in patients with cirrhosis]
Anna Amato1, Davide Ferdinando Precone, Novella Carannante
1Divisione Epatiti Virali Acute e Croniche, Dipartimento di Malattie Infettive, Seconda Universita di Napoli, Italy.
Insights
Bacteriuria (bacteria in urine) affects 27.8% of cirrhosis patients. Female gender and diabetes, not cirrhosis severity, are key risk factors for this common urinary tract infection.
Area of Science:
- Urology
- Infectious Diseases
- Hepatology
Context:
- Bacterial infections are common in cirrhosis patients, potentially worsening outcomes.
- Cirrhosis impacts various bodily systems, increasing susceptibility to infections.
- Urinary tract infections, specifically bacteriuria, represent a significant concern in this population.
Purpose:
- To determine the prevalence of bacteriuria in patients with cirrhosis.
- To identify risk factors associated with bacteriuria in cirrhosis patients.
- To analyze the relationship between bacteriuria and cirrhosis severity (Child-Pugh stage).
Summary:
- A study of 500 cirrhosis patients found a 27.8% prevalence of bacteriuria.
- Escherichia coli was the predominant pathogen.
- Univariate and multivariate analyses identified female gender and diabetes as significant risk factors, independent of cirrhosis severity or hepatocellular carcinoma.
Impact:
- Findings suggest that common risk factors like female gender and diabetes, rather than advanced cirrhosis, are primary drivers of bacteriuria.
- This challenges the assumption that cirrhosis itself is a major risk factor for bacteriuria.
- Highlights the need to consider non-cirrhosis-specific risk factors in managing urinary tract infections in these patients.
Abstract:
Bacterial infections occur frequently in patients with cirrhosis and may worsen the disease outcome. We investigated the prevalence of bacteriuria in 500 consecutive patients with cirrhosis, in different Child-Pugh stages (41.4% A; 40.8% B; 17% C) and analysed the associated risk factors. Most of the cirrhosis cases were virus related; alcohol abuse was recorded in 6.2% of the patients. Bacteriuria was detected in 139 (27.8%) cases: 32.4% were more than 100,000 cfu/ml; 7.9% between 100,000 and 1.000,000 cfu/ml and the remaining cases more than 1000,000 cfu/ml. Escherichia coli was the most frequent isolated agent (84.5%); Proteus spp. strains were detected only in bacteriuria with more than 100,000 cfu/ml. At univariate analysis, female gender, age and presence of diabetes were significantly associated to bacteriuria, while Child-Pugh stage and the presence of hepatocellular carcinoma were not. In a multivariate model, only female gender and diabetes were significantly associated to bacteriuria. These results indicate that advanced cirrhosis was not a risk for bacteriuria, that was associated rather to gender and diabetes, which are common risk factors for bacteriuria in non-cirrhotic patients.
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