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Prevalence and Impact of Bacterial Infections in Children With Liver Disease-A Prospective Study
Rishi Bolia1, Anshu Srivastava1, Rungmei Marak2
1Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Insights
Bacterial infections are common in children with Acute Liver Failure (ALF) and Decompensated Chronic Liver Disease (DCLD), especially Healthcare-Associated infections. DCLD patients with infections face worse outcomes, unlike ALF patients.
Area of Science:
- Pediatric Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Patients with Acute Liver Failure (ALF) and Decompensated Chronic Liver Disease (DCLD) have an increased risk of infections.
- Bacterial infections pose a significant threat to pediatric liver disease patients, impacting prognosis.
Purpose of the Study:
- To determine the frequency, location, type, and risk factors of bacterial infections in children with ALF and DCLD.
- To assess the impact of these infections on patient outcomes.
Main Methods:
- Prospective enrollment of pediatric patients diagnosed with ALF or DCLD.
- Collection of clinical and laboratory data, including blood, urine, and ascites cultures, and chest X-rays.
- Weekly surveillance cultures were performed to monitor for infections.
Main Results:
- Infections were more prevalent in DCLD (57.1%) than ALF (39.7%) patients.
- Healthcare-Associated (HCA) infections were the most frequent type (44.8%), followed by Nosocomial (NC) and Community-Acquired (CA).
- High resistance rates to cephalosporins and quinolones were observed, with 23% of isolates being Multiresistant Bacteria (MRB). DCLD patients with infections showed higher mortality rates.
Conclusions:
- Infections occur in a significant proportion of children with ALF (40%) and DCLD (57%).
- HCA and NC infections constitute the majority (77%) of infections in this cohort.
- Advanced liver disease in DCLD patients is associated with a higher risk of infection and poorer outcomes.
Background And Aims:
Risk of infections is increased in patients with Acute Liver Failure (ALF) and Decompensated Chronic Liver Disease (DCLD). We evaluated the frequency, site, type and risk-factors for bacterial infections in children with ALF and DCLD and its effect on outcome.
Methods:
ALF or DCLD children were enrolled prospectively. Clinical and laboratory details were recorded. Cultures (blood, urine and ascites) and chest X-ray were done at admission followed by weekly surveillance cultures.
Results:
173 patients, 68 ALF and 105 DCLD were enrolled. Infections were more common in DCLD than ALF (60/105 [57.1%] vs. 27/68 [39.7%]; P = 0.02). Ascitic fluid infection, pneumonia, urinary tract infection and bacteremia were seen in 19%, 17.9%, 13.2% and 12.1% patients respectively. Healthcare-Associated (HCA) infections were most frequent (39/87, 44.8%), followed by Nosocomial (NC, 32%) and Community-Acquired (CA, 23%). Nearly 3/4th of bacterial isolates were resistant to cephalosporins and quinolones, 23% being Multiresistant Bacteria (MRB). DCLD patients with infection had higher Child-Pugh Score (10 [6-14] vs. 7 [6-14]; OR 3.2 [1.77-5.10]: P = 0.007), need for ICU care (26/60 vs. 3/45; OR 10.70 [2.98-38.42]: P = 0.01), in-hospital mortality (24/60 vs. 8/45;OR 3.08 [1.22-7.75]: P = 0.04) and mortality at 3 month follow-up (32/60 vs. 9/45; OR 4.57 [1.87-11.12]: P = 0.00). Infection did not affect the outcome in ALF.
Conclusion:
Infections develop in 40% ALF and 57% DCLD children. HCA and NC infections account for 77% of infections. Most culture isolates are resistant to cephalosporins and fluoroquinolones and 23% have MRB. Risk of infections is higher in DCLD patients with advanced liver disease.
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