Schneitler S, Schneider C, Casper M, Lammert F, Krawczyk M, Becker SL, Reichert MC. Retrospective study of the incidence, risk factors, treatment outcomes of bacterial infections at uncommon sites in cirrhotic patients. World J Hepatol 2024; 16(3): 418-427 [PMID: 38577541 DOI: 10.4254/wjh.v16.i3.418]
Corresponding Author of This Article
Sophie Schneitler, MD, Consultant Physician-Scientist, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße 100, Homburg 66421, Germany. sophie.schneitler@uks.eu
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Mar 27, 2024; 16(3): 418-427 Published online Mar 27, 2024. doi: 10.4254/wjh.v16.i3.418
Retrospective study of the incidence, risk factors, treatment outcomes of bacterial infections at uncommon sites in cirrhotic patients
Sophie Schneitler, Christina Schneider, Markus Casper, Frank Lammert, Marcin Krawczyk, Sören L Becker, Matthias Christian Reichert
Sophie Schneitler, Sören L Becker, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg 66421, Germany
Christina Schneider, Markus Casper, Frank Lammert, Marcin Krawczyk, Matthias Christian Reichert, Department of Medicine II, Saarland University Medical Center, Homburg 66421, Germany
Frank Lammert, Health Sciences, Hannover Medical School, Hannover 30625, Germany
Marcin Krawczyk, Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Centre for Preclinical Research, Medical University of Warsaw, Warsaw 02-097, Poland
Author contributions: Reichert MC, Schneitler S, Lammert F, and Becker SL designed the study; Reichert MC, Casper M, Schneider C, and Schneitler S participated in the acquisition of clinical data, drafted the manuscript, and together with Krawczyk M and Becker SL, analyzed the data and finalized the manuscript, which was then revised by all authors; the final draft of the manuscript was approved by all authors.
Institutional review board statement: The study was conducted according to the Declaration of Helsinki and Good Clinical Practice (European guidelines). Institutional review board approval was obtained by the Ethikkommission der Ärztekammer des Saarlandes (approval 71/11).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors declare that they do not have anything to disclose regarding conflicts of interest with respect to this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sophie Schneitler, MD, Consultant Physician-Scientist, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße 100, Homburg 66421, Germany. sophie.schneitler@uks.eu
Received: December 6, 2023 Peer-review started: December 6, 2023 First decision: December 19, 2023 Revised: January 2, 2024 Accepted: February 8, 2024 Article in press: February 8, 2024 Published online: March 27, 2024 Processing time: 107 Days and 13.9 Hours
Abstract
BACKGROUND
Bacterial infections (BI) negatively affect the natural course of cirrhosis. The most frequent BI are urinary tract infections (UTI), pneumonia, and spontaneous-bacterial peritonitis (SBP).
AIM
To assess the relevance of bacterial infections beyond the commonly recognized types in patients with cirrhosis and to investigate their relationship with other clinical variables.
METHODS
We retrospectively analyzed patients with cirrhosis and BI treated between 2015 and 2018 at our tertiary care center. BIs were classified as typical and atypical, and clinical as well as laboratory parameters were compared between the two groups.
RESULTS
In a cohort of 488 patients with cirrhosis, we identified 225 typical BI (95 UTI, 73 SBP, 72 pulmonary infections) and 74 atypical BIs, predominantly cholangitis and soft tissue infections (21 each), followed by intra-abdominal BIs (n = 9), cholecystitis (n = 6), head/throat BIs (n = 6), osteoarticular BIs (n = 5), and endocarditis (n = 3). We did not observe differences concerning age, sex, or etiology of cirrhosis in patients with typical vs atypical BI. Atypical BIs were more common in patients with more advanced cirrhosis, as evidenced by Model of End Stage Liver Disease (15.1 ± 7.4 vs 12.9 ± 5.1; P = 0.005) and Child-Pugh scores (8.6 ± 2.5 vs 8.0 ± 2; P = 0.05).
CONCLUSION
Atypical BIs in cirrhosis patients exhibit a distinct spectrum and are associated with more advanced stages of the disease. Hence, the work-up of cirrhosis patients with suspected BI requires detailed work-up to elucidate whether typical BI can be identified.
Core Tip: Bacterial infections (BI) affect the natural course of liver cirrhosis and can trigger decompensation or death. The most frequent BI in cirrhosis (urinary tract infections, pneumonia or spontaneous-bacterial peritonitis) were retrospectively compared to infections at other body sites, which are thought to be less frequently affected (so-called “atypical BI”). When comparing typical/atypical BI, no differences in age, sex, or etiology of cirrhosis were found. Notably, for atypical BI, the stage of cirrhosis was less advanced, as expressed by laboratory parameters and clinical scores (e.g. Model of End Stage Liver Disease - and Child-Pugh-Score).
