Cirrhotic Patients Are at Risk for Health Care-Associated Bacterial Infections
Cirrhotic Patients Are at Risk for Health Care-Associated Bacterial Infections
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DOI：
10.1016/j.cgh.2010.06.024
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发表时间：
2010-11-01
影响因子：
12.6
通讯作者：
Venditti, Mario
中科院分区：
文献类型：
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作者：
Merli, Manuela;Lucidi, Cristina;Venditti, Mario
背景与目的细菌感染是肝硬变患者常见而严重的负担，因为它们可进一步恶化肝功能。我们对住院的肝硬变患者的流行病学危险因素和临床后果进行了评估。方法在一组住院的肝硬变患者(n=150)中，前瞻性地记录了所有细菌感染的发病情况，将感染归类为社区获得性(CA)、医疗保健相关(HCA)或医院获得性(HA)感染部位，报道了细菌的特性和抗生素耐药的发生率，并对其对肝功能和患者生存的影响进行了评估。感染的独立预测因素包括过去12个月内有过一次感染(P=0 0 0 1，95%可信区间[CI]2 2~10 6)、终末期肝病模型和GT；=15(P=0 1，95%CI，1 3~6 1)和蛋白质营养不良(P=0 4，95%CI，1 5~10)感染性发作使患者的肝、功能恶化，62%的感染患者出现腹水、肝性脑病、低钠血症、肝肾综合征或感染性休克Child C级(P=0 0 6，95%CI，1 67~2 3 7)、败血症(P=0 0 5，95%CI，1 7~2 1 4)和蛋白质营养不良(P=0 0 0 95%CI 2 8 38 5)。最常见的感染是HCA和HA，这些感染往往对抗生素产生抗药性，因为感染恶化，肝功能恶化，死亡率增加，应密切监测肝硬变患者的感染情况
BACKGROUND & AIMS Bacterial infections are a frequent and serious burden among patients with cirrhosis be cause they can further deteriorate liver function We assessed the epidemiology risk factors, and clinical consequences of bacterial infections in hospitalized cirrhotic patients METHODS In a cohort of hospitalized cirrhotic patients (n = 150) referred the a tertiary cat e setting, all episodes of bacterial infections were recorded prospectively Infections were classified as community acquired (CA), health care-associated (HCA), or hospital acquired (HA) Site of infection, charactetistics of bacteria, and prevalence of antibiotic resistance were reported, consequences for liver function and patient survival were evaluated RESULTS Fifty four infections were observed among 50 patients (12 CA, 22 HCA, and 20 HA) Bacterial resistance was more frequent among patients with HCA or HA infections (64% of isolates) Mortality was 37% from HA, 36% from HCA, and 0% from CA infections Independent predictors of Infection Included a previous infection within the past 12 months (P = 0001, 95% confidence interval [CI], 2 2-10 6), model of end stage liver disease store >= 15 (P = 01, 95% CI, 1 3-6 1), and protein malnutrition (P = 04, 95% CI, 1 5-10) Infectious episodes worsened live, function in 62% of patients Patients with infection more frequently developed ascites, hepatic encephalopathy, hyponatamia, hepatorenal syndrome, or septic shock Child class C (P = 006, 95% CI, 1 67-23 7), sepsis (P = 005, 95% CI, 1 7-21 4) and protein malnutrition (P = 001 95% CI 2 8 38 5) increased mortality among patients in the hospital CONCLUSIONS In hospitalized cirrhotic patients, the most frequent infections are HCA and HA, these infections are frequently resistant to antibiotics As infections worsen, liver function deteriorates and mortality increases Cirrhotic patients should be monitored closely for infections