Burden and Impact of Multidrug Resistance Infection on Outcome of the Patients with Decompensated Liver Disease in a Tertiary Care Institute DC10-DC14
Dr. Narayanasamy Krishnasamy,
Director and Professor, Institute of Hepatobilary Sciences Madras Medical College and Rajiv Gandhi Government General Hospital, Park Town, Chennai, Tamil Nadu, India.
Introduction: Cirrhosis-Associated Immune Dysfunction (CAID) increases the risk of development of infection which progresses to sepsis and death. Most common infection associated with liver cirrhosis patients are Spontaneous Bacterial Peritonitis (SBP) and Urinary Tract Infections (UTI), together they make up about two thirds of these infections, while the remainder belongs to infections of the skin and soft tissue, bacteremia and other infections. There are increasing numbers of Multidrug Resistant Strains (MDRs) emerging especially in the hospital setting.
Aim: To assess the prevalence of bacterial infection, MDR pattern among the isolates, infection status in correlation with Child-Turcotte-Pugh (CTP) score, survival rate and mortality rate.
Materials and Methods: This retrospective study includes 359 consecutive hospitalised cirrhotic patients from August 2017-July 2018. Based on the clinical examination, laboratory findings and culture positivity, the bacterial infections were diagnosed accordingly.
Results: The prevalence of bacterial infection was 29.80%. The most common infections were UTI (51.56%) followed by Blood Stream Infection (BSI) (24.21%), SBP (14.06%) and Skin and soft tissue infections (7.03%). The most common isolates were Escherichia coli, Staphylococcus spp, Klebsiella spp, Enterococus spp, and among Fungi were Candida spp. Among bacterial isolates 55.9% turned out to be MDR. The mortality rate was high (61.1%) among the patients with infection and patients with CTP-C (=10 points) with multiple infections which showed significantly higher mortality rate. Based on the source and development of infection, majority were under community-acquired infections (39.84%) followed by nosocomial (38.29%) and healthcare associated (21.87%). A higher MDR (68.18%) among nosocomial infections were observed.
Conclusion: Increased trend of MDR in nosocomial and healthcare associated infections, shows increased failure rates of empirical antibiotic treatment and necessitates the implementation of Antibiotic stewardship programs. Infections acts as precipitating factor for liver function deterioration thereby increases the chance of mortality. So, the patients with cirrhosis should be carefully monitored for infections.