Comparison of Bacterial Infections in Patients With Cirrhosis Between Hospitals With and Without Liver Transplant in Catalonia

IF 6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver International Pub Date : 2025-04-11 DOI:10.1111/liv.70076

Clàudia Torras, Juan Bañares, Aina Martí-Carretero, Víctor Acin, Laura Pagès, Laura Gutiérrez-Rios, Antonio Casabella, José Ferrusquía-Acosta, Jordi Sánchez-Delgado, Martina Pérez, Diana Fuertes, Marta Garcia-Guix, Berta Cuyàs, Helena Masnou, Alberto Amador, German Soriano, Juan M. Pericàs, Oriol Gasch, Cristina Solé

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引用次数: 0

Abstract

Background and Aims

Infections by multidrug resistant (MDR) bacteria are increasing and vary across regions and hospitals. We aimed to assess the epidemiology, prevalence, and outcomes of bacterial infections in patients with decompensated cirrhosis, comparing liver transplant (LT) and non-LT centers in Catalonia.

Methods

This is a multicenter retrospective study including all patients with decompensated cirrhosis and bacterial infections hospitalised between January 2021 and 2022 from 5 university hospitals in the Barcelona metropolitan area. Two of them were LT centres. Clinical, laboratory, microbiological data, and in-hospital mortality were collected.

Results

A total of 576 infections were reported in 352 patients. LT centers had more health-related infections, recurrent infections, and septic shock than non-LT centers, while there were no differences in cirrhosis severity, acute-on-chronic liver failure (ACLF) or comorbidities. Although the most commonly isolated microorganisms and types of infection were similar in both centers, LT centers had higher rates of extended-spectrum beta-lactamase (12% vs. 6%), carbapenem (3% vs. 0%) and piperacillin-tazobactam resistant bacteria (14% vs. 7%). MDR rate was also higher in LT centers (38% vs. 25%, p = 0.02) and varied across hospitals (18%–42%, p < 0.05). Furthermore, in-hospital mortality was higher in LT centers (20% vs. 10%; p = 0.01). Independent predictors of in-hospital mortality were septic shock, ACLF, Child-Pugh, age, and leukocyte count.

Conclusions

Our study showed differences in epidemiology, prevalence of MDR infections, and outcomes across university hospitals, particularly between centers with and without LT. Further studies are warranted to unveil the nuances of bacterial infections across different healthcare institutions in Europe and elsewhere.

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加泰罗尼亚地区肝移植医院与非肝移植医院肝硬化患者细菌感染的比较

背景和目的耐多药（MDR）细菌感染正在增加，并且在不同地区和医院有所不同。我们的目的是评估失代偿性肝硬化患者的流行病学、患病率和细菌感染的结局，比较加泰罗尼亚的肝移植（LT）和非LT中心。方法：这是一项多中心回顾性研究，纳入了2021年1月至2022年1月期间在巴塞罗那市区5所大学医院住院的所有失代偿性肝硬化和细菌感染患者。其中两个是LT中心。收集临床、实验室、微生物学数据和住院死亡率。结果352例患者共报告感染576例。与非肝移植中心相比，肝移植中心有更多与健康相关的感染、复发性感染和脓毒性休克，而在肝硬化严重程度、急性慢性肝衰竭（ACLF）或合并症方面没有差异。虽然两个中心最常见的分离微生物和感染类型相似，但LT中心的广谱β -内酰胺酶（12%比6%）、碳青霉烯（3%比0%）和哌拉西林-他唑巴坦耐药菌（14%比7%）的比例更高。多药耐药率在肝移植中心也较高（38% vs. 25%, p = 0.02），不同医院间差异较大（18%-42%,p < 0.05）。此外，肝移植中心的住院死亡率更高(20% vs. 10%；p = 0.01)。院内死亡率的独立预测因子为感染性休克、ACLF、Child-Pugh、年龄和白细胞计数。我们的研究显示了流行病学、耐多药感染的患病率和大学医院的结果差异，特别是在有无lt的中心之间。需要进一步的研究来揭示欧洲和其他地方不同医疗机构细菌感染的细微差别。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.