Multidrug-resistant bacterial infections in cirrhotic patients: an epidemiological study

The purpose of this study is to describe the epidemiological features of bacterial infections caused by multidrug-resistant (MDR) bacteria in cirrhotic patients and their impact on mortality.

A retrospective study of cirrhotic patients with culture-confirmed bacterial infections was performed between 2011 and 2017.

A total of 635 episodes in 563 patients with cirrhosis were included. Bacterial infections caused by MDR isolates accounted for 44.1% (280/635) of the episodes, nearly half of which were hospital acquired (48.4%). The most common MDR isolation site was the respiratory tract (36.4%, 102 episodes), followed by the abdominal cavity (35.4%, 99 episodes). Of the MDR isolates, carbapenem-resistant Enterobacteriaceae (CRE) (91 episodes) were the most common. Patients infected with MDR bacteria had significantly higher mortality than those not infected (25.1% vs 17.4%, p = 0.025). However, this increased mortality could be largely attributed to methicillin-resistant Staphylococcus aureus (MRSA). After adjustment for age, sex, and the model for end-stage liver disease (MELD) score, only MRSA infection was an independent risk factor for 28-day mortality in the multivariable Cox proportional hazard regression model analysis (HR, 2.964, 95% CI (1.175-7.478), p = 0.021).

MDR bacterial infections, especially CRE, have become frequent in patients with cirrhosis in recent years, with MRSA infections significantly increasing short-term mortality.