Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study

Aims. To evaluate the prevalence, incidence and clinical relevance of bacte rial infection in predominantly non-alcoholic cirrhotic patients hospitalis ed for decompensation. Patients/Methods. A total of 405 consecutive admissions in 361 patients (24 9 males and 112 females; 66 Child-Pugh class B and 295 class C) were analys ed. 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 communi ty- 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%). Commun ity-acquired infections were associated with more advanced liver disease (C hild-Pugh mean score 10.2 +/- 2.1 versus 9.5 +/- 1.9, p < 0.05), renal fail ure (p < 0.05), and high white blood cell count (p < 0.01). Hospital-acquir ed infections occurred more frequently in patients admitted for gastrointes tinal bleeding (p < 0.05). The in-hospital mortality was significantly high er 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 stay Conclusions. Bacterial infection, regardless of the aetiology, is a severe complication of decompensated cirrhosis, and, although frequently asymptoma tic, accounts for both longer hospital stay and increased mortality.