Bacterial resistance profile and its association with poor outcome among cirrhosis patients attending a tertiary care referral center in northern India.

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Gerlin Varghese, Ashima Jamwal, Deepika Sarawat, Surender Singh, Nidhi Tejan, Sangram Singh Patel, Chinmoy Sahu

Author Information

Gerlin Varghese: Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India.
Ashima Jamwal: Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India.
Deepika Sarawat: Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India.
Surender Singh: Department of Hepatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India. surmmcian2k6@gmail.com.
Nidhi Tejan: Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India.
Sangram Singh Patel: Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India.
Chinmoy Sahu: Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India. chinmoyresearch@gmail.com. ORCID

PMID: 39921835 DOI: 10.1007/s12664-024-01712-0

BACKGROUND AND OBJECTIVE: The epidemiological connections, predisposing factors and clinical outcomes of infections by drug-resistant bacteria in cirrhosis are poorly documented. Thus, this study was conducted to assess the risk factors, complications and patterns of bacterial resistance among these patients.
METHODS: This retrospective observational study was conducted from March 1, 2021, to July 31, 2023, at a tertiary care centre in Uttar Pradesh. patients of cirrhosis aged ≥ 18 years with microbial infection were included in the study. Samples, as indicated, were sent to the microbiology lab for culture and sensitivity. The patient's clinical history, details regarding bacterial culture and antibiotic sensitivity results were extracted from the hospital information system (HIS) and entered into an excel sheet. Univariate analysis of the variables was done and the statistical significance of these variables was determined using the p-value. A p-value of < 0.05 was considered significant.
RESULTS: During the study period, 765 patients were diagnosed with cirrhosis, of which 248 (32%) had a positive bacterial culture report. Among them, 206 (83.1%) patients recovered and were discharged in stable condition. Among the cirrhotic patients, the most common infection was spontaneous bacterial peritonitis (49.5%), followed by bacteremia (39.1%), lower respiratory tract infections (6.4%), urinary tract infections (2.9%) and skin and soft tissue infections (2%). Escherichia coli (28%) was the most common gram-negative bacteria. Multidrug-resistant organism infections were seen in 134 (54%) patients. Multidrug-resistant (MDR) infection (31.4%) and extensively drug-resistant (XDR) infection (22.6%) were significantly associated with poor outcomes among these patients. Carbapenem-resistant organisms (22.6%) were the predominant resistant patterns seen among the gram-negative isolates in cirrhosis patients. The mortality rate among these cirrhotic patients with bacterial infection was 16.9%.
CONCLUSIONS: MDR and XDR bacterial infections in cirrhotic patients are an emerging threat that has a detrimental effect on prognosis. Thus, it is critical to assess strategies to prevent the development of antibiotic resistance in cirrhosis.

Escherichia coli Bacterial infection Carbapenem resistance Cirrhosis Drug resistance Enterobacterales

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Humans

Liver Cirrhosis

Retrospective Studies

Male

India

Female

Tertiary Care Centers

Middle Aged

Drug Resistance, Bacterial

Anti-Bacterial Agents

Risk Factors

Adult

Bacterial Infections

Aged

Peritonitis

Microbial Sensitivity Tests

Anti-Bacterial Agents

Journal Article Observational Study

No available data.

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