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Bacteremia in patients with cirrhosis of the liver
C H Kuo1, C S Changchien, C Y Yang
1Department of Gastroenterology, Chang Gung Memorial Hospital, Kaoshiung, Linko, Taiwan, Republic of China.
Abstract:
Infections are frequent in patients with liver cirrhosis, as their defenses against infectious agents are altered. But bacteremia occurring in cirrhotic patients has seldom been reported in the literature. From 1981 to 1986, we collected 197 cases with 228 episodes of bacteremia for this retrospective study. The incidence of bacteremia in cirrhotic patients was 8.8%; no significant difference was noted between cirrhotic patients with variant etiologies of HBV(+), HBV(-) and alcohol. But the incidence increased with the severity of the disease (1%, 4.8%, 17.1% in Child's A, B, C groups, respectively). Gram-negative bacteria were the predominant microorganisms of bacteremia (75.6%). Among them, Escherichia coli, Klebsiella pneumoniae and Aeromonas hydrophilia were the three most commonly detected microorganisms. Gram-positive bacterias were detected in 21.2% of patients with bacteremia, with predominance of the Streptococcus group and Staphylococcus aureus. In about 26.3% of cases the infectious sources were the same by bacteria cultures as from blood. The most common sources were spontaneous bacterial peritonitis, urinary tract infection, pneumonia and biliary tree infection. In cirrhotic patients with and without bacteremia, the mortality rate increased significantly in the bacteremia group (54.8% vs 23.2%, P less than 0.05). By Child's classification, the mortality of patients with classes B and C increased significantly after onset of bacteremia. There was no significant difference in mortality between bacteremic patients in the HBV(+), HBV(-) and alcohol groups. In conclusion, bacteremia is a severe complication of liver cirrhosis and a sign of a poor prognosis.
Insights
Bacteremia, or bloodstream infection, is a serious complication in liver cirrhosis patients, significantly increasing mortality risk. Its incidence rises with disease severity, with Gram-negative bacteria being most common.
Area of Science:
- Infectious Diseases
- Hepatology
- Critical Care Medicine
Background:
- Liver cirrhosis impairs immune defenses, increasing infection susceptibility.
- Bacteremia in cirrhotic patients is underreported despite its potential severity.
Purpose of the Study:
- To determine the incidence, causative agents, sources, and prognostic impact of bacteremia in liver cirrhosis patients.
- To analyze bacteremia prevalence across different liver disease etiologies and severity.
- To assess the impact of bacteremia on mortality in cirrhotic patients.
Main Methods:
- Retrospective study of 197 cirrhotic patients with 228 bacteremia episodes from 1981 to 1986.
- Analysis of bacteremia incidence, microbial patterns, infection sources, and mortality rates.
- Comparison of outcomes based on Child's classification and etiological factors (HBV, alcohol).
Main Results:
- Bacteremia incidence was 8.8%, increasing with disease severity (Child's A, B, C: 1%, 4.8%, 17.1%).
- Gram-negative bacteria (75.6%) predominated, with Escherichia coli, Klebsiella pneumoniae, and Aeromonas hydrophilia most common.
- Mortality was significantly higher in patients with bacteremia (54.8% vs 23.2%), especially in Child's B and C classes.
Conclusions:
- Bacteremia is a severe complication of liver cirrhosis with a poor prognosis.
- Disease severity, not etiology (HBV, alcohol), significantly impacts bacteremia incidence.
- Prompt recognition and management of bacteremia are crucial for improving outcomes in cirrhotic patients.