Bacterial infection in patients with advanced cirrhosis:: a multicentre prospective study
Bacterial infection in patients with advanced cirrhosis:: a multicentre prospective study
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DOI：
10.1016/s1590-8658(01)80134-1
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发表时间：
2001-01-01
影响因子：
4.5
通讯作者：
Sangiovanni, A
中科院分区：
文献类型：
--
作者：
Borzio, M;Salerno, F;Sangiovanni, A
目标。目的：评估以非酒精性肝硬变患者为主的失代偿住院患者细菌感染的患病率、发生率和临床相关性。共分析了361名患者的405名连续住院患者(249名男性和112名女性；66名Child-Pugh B级和295名C级)。血液、尿液、腹水和胸水在最初的24小时内，在怀疑感染的住院期间，以及出院前再次进行培养。在一年的时间里，诊断出150例(34%)细菌感染(89例社区感染和61例医院感染)，涉及尿路(41%)、腹水(23%)、血液(21%)和呼吸道(17%)。细菌性腹膜炎患病率为12%。无症状感染89例(46%)，单个部位感染130例(87%)。肠道菌群占感染的62%，其中大肠埃希菌是最常见的致病菌(25%)。社区获得性感染与更严重的肝病(Child-Pugh平均评分10.2+/-2.1比9.5+/-1.9，p<；0.05)、肾功能衰竭(p<；0.05)和高白细胞计数(p<；0.01)相关。医院获得性感染在因胃肠道出血入院的患者中发生得更频繁(p<；0.05)。感染患者的住院死亡率显著高于非感染患者(15%比7%，p<；0.05)，感染成为影响生存的独立变量，而且细菌感染显著延长了患者的住院时间。细菌感染，无论病因如何，都是失代偿性肝硬变的严重并发症，虽然经常没有症状，但导致住院时间更长和死亡率增加。
Aims. To evaluate the prevalence, incidence and clinical relevance of bacterial infection in predominantly non-alcoholic cirrhotic patients hospitalised for decompensation.Patients/Methods. A total of 405 consecutive admissions in 361 patients (249 males and 112 females; 66 Child-Pugh class B and 295 class C) were analysed. Blood, urine, ascitic and pleural fluid cultures were performed within the first 24 hours, during hospitalisation whenever infection was suspected, and again before discharge.Results. Over a one year period, 150 (34%) bacterial infections (89 community- and 61 hospital-acquired) involving urinary tract (41%), ascites (23%), blood (21%) and respiratory tract (17%) were diagnosed. The prevalence of bacterial peritonitis was 12%. infections were asymptomatic in 89 cases (46%) and 130(87%) involved a single site. Enteric flora accounted for 62% of infections, Escherichia Coli being the most frequent pathogen (25%). Community-acquired infections were associated with more advanced liver disease (Child-Pugh mean score 10.2 +/- 2.1 versus 9.5 +/- 1.9, p < 0.05), renal failure (p < 0.05), and high white blood cell count (p < 0.01). Hospital-acquired infections occurred more frequently in patients admitted for gastrointestinal bleeding (p < 0.05). The in-hospital mortality was significantly higher in infected than in non-infected patients (15% versus 7%, p < 0.05), and infection emerged as an independent variable affecting survival, Moreover, bacterial infection accounted for a significantly prolonged hospital stayConclusions. Bacterial infection, regardless of the aetiology, is a severe complication of decompensated cirrhosis, and, although frequently asymptomatic, accounts for both longer hospital stay and increased mortality.