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Nosocomial infections among cirrhotic patients increased, showed association with mortality

The rates of hospitalized patients with cirrhosis who were diagnosed with bacterial infections have increased and contributed to overall mortality, according to data from a new study.

Ashwani K. Singal, MD, assistant professor in the division of gastroenterology and hepatology, University of Alabama, and colleagues reviewed 742,391 admissions from the Nationwide Inpatient Sample database between 1998 and 2007 to measure infection trends among hospitalized cirrhotic patients. Patients were divided into subgroups based on evidence of cirrhosis-related complications and common infections. They included spontaneous bacterial peritonitis (SBP), Clostridium difficile infection, pneumonia, skin and soft tissue infection (SSCI), and urinary tract infection (UTI).

 

Ashwani K. Singal

Data revealed that the mortality rate among cirrhotic patients was greater compared with uninfected cirrhotic patients (16.3% vs. 3.2%, P<.0001). Twenty-three percent (168,654) of all patient admissions showed discharge diagnoses of any infection. Infection among cirrhotic patients increased among all subgroups — except patients with esophageal variceal hemorrhage (EVH) and EVH with ascites — from 21% to 25% during the study. Infection rates were related to renal sufficiency (38% to 43%), in which infection doubled, and ascites (22% to 25%).

Infection prevalence increased for C. difficile (0.7% to 1.6%), SSCI (4.6% to 6.1%) and UTI (9.4% to 12%) (P<.0001 for all). SBP remained unchanged, and pneumonia declined (1.6% to 1.3%; (P<.0001). The most common infections were UTI (11.2%), skin and subcutaneous tissue infections (5.9%), SBP (2%), C. difficile (1.6%) and pneumonia (1.4%).

Regression analyses revealed that women were more likely to be diagnosed with any infection (OR=1.47; 95% CI, 1.39-1.56) compared with men, and African-Americans were less likely to acquire infection (OR=0.78; 95% CI, 0.71-0.85) than white patients.

“Infection is a common complication among hospitalized cirrhotics in the US,” the researchers wrote. “Unfortunately, the prevalence of infection in these patients is increasing and is associated with substantial in-hospital morbidity, mortality and increased use of hospital resources.”