Treatment of Hospital-Acquired Infections in Patients with Cirrhosis – New Challenges

Figures & data

Table 1 Baseline Characteristics of the Patients

Laboratory Parameter	Attribute	No. of Patients	%
Age in years (n^a =40)	≤30	1	2.5
	>30–40	3	7.5
	>40–50	9	22.5
	>50–60	16	40.0
	>60	11	27.5
Sex (n^a=40)	M	36	90
	F	4	10
Haemoglobin (g/dl) (N^b=45)	>12	5	11.1
	10–12	14	31.1
	8-<10	11	24.4
	< 8	15	33.3
Total white blood cell count (cells/mm^3) (N^b =45)	< 4000	3	6.67
	4000–11,000	17	37.8
	>11,000	25	55.5
Serum creatinine (mg/dl) (N^b =45)	<1.0	5	11.1
	>1.0–1.5	15	33.3
	>1.5	25	55.5
Serum sodium (mmol/l) (N^b =45)	>135	2	4.44
	130–135	6	13.3
	125-<130	10	22.2
	120-<125	23	51.1
	<120	4	8.9
Total serum bilirubin (mg/dl) (N^b =45)	<2	5	11.1
	2–3	10	22.2
	>3	30	66.7
International Normalised Ratio (INR) (N^b =45)	< 1.7	9	20
	1.7–2.3	11	24.4
	>2.3	25	55.5
Serum albumin (g/dl) (N^b =45)	<2.8	23	51.1
	2.8–3.5	18	40.0
	>3.5	4	8.9
Model for End stage Liver Disease (MELD) score (N^b =45)	≤10	1	2.2
	>10-15	3	6.67
	>15.1	41	91.1
Child Turcotte Pugh (CTP) class (N^b =45)	Class A (<7)	0	0
	Class B (7–9)	9	20.0
	Class C (>9)	36	80.0

Notes: (N^a =40) = No. of patients, (N^b =45)= No. of hospital admissions.

Table 2 Types of Infections Observed Among Patients

Type of Infection	No. of Patients
UTI	20
Cellulitis	6
Spontaneous bacteraemia (SB)	5
Respiratory tract infections (RTI)	9
Ascitic fluid infections (AFI)	13
Tuberculosis	0
Other	2
Total	55

Table 3 ESBL Infections Observed Among Patients

Infections	Bacteria Species		Total
	E. coli	K. pneumoniae
UTI	1	2	3
Sepsis	1	0	1
AFI	6	0	6
Cellulitis	1	0	1
Respiratory	0	0	0
Pyometra	0	1	1
Total	9/10(90%)	3/11(27.27%)	12/30(40%)

Table 4 Frequency of Drug Resistance in Isolated Organisms

Bacteria	n	MDR	XDR	PDR	Total
E coli	10	10	0	0	10
K. pneumoniae	11	6	5	0	11
Pseudomonas aeruginosa	4	1	1	0	2
Acinetobacter	4	3	1	0	4
Citrobactor	1	1	0	0	1
Staphylococcus aureus	12	7	0	0	7
Enterococcus	13	8	1	0	8
Total	55	36	8	0	44

Table 5 Drug Resistance Patterns in Isolated Gram Negative Organisms

Bacteria	n	Frequency of Resistance to Antibiotics
		Cep	Que	PT	Car.	Amg	TG	Col
E coli	10	10/10	10/10	5/10	2/10	5/10	0/10	0/10
K. pneumoniae	11	11/11	10/11	9/11	6/11	10/11	0/11	1/11
Pseudomonas aeruginosa	4	2/4	2/4	1/4	2/4	2/4	NT	0/4
Acinetobacter	4	4/4	3/4	3/4	4/4	3/4	0/4	1/4
Citrobactor	1	1/1	1/1	0/1	0/1	1/1	NT	NT
Total	30	28/30	26/30	18/30	14/30	21/30	0/25	2/29
		93.33%	86.66%	60%	46.66%	70%	0%	6.89%

Abbreviations: Cep, cephalosporin; Que, quinolones; PT, piperacillin-tazobactum; Car, carbapenem; Amg, aminoglycoside; Tg, tigecycline; TCol, colistin; NT, not tested.

Table 6 Drug Resistance Patterns in Isolated Gram Positive Organisms

Bacteria	n	Frequency of Resistance to Antibiotics
		Cep	Que	PT	Car.	Amg	TG	T	V	L	Col
Staphylococcus aureus	12	9/12	12/12	NT	NT	8/12	0/12	0/12	0/12	0/12	NT
Enterococcus	13	NT	13/13	10/13	11/13	13/13	0/13	0/13	0/13	NT	NT
Total	25	9/12	25/25	10/13	11/13	21/25	0/25	0/25	0/25	0/12	NT
		75%	100%	80%	84.6%	84%	0%	0%	0%	0%	–

Abbreviations: Cep, cephalosporin; Que, quinolones; PT, piperacillin-tazobactum; Car, carbapenem; Amg, aminoglycoside; Tg, tigecycline; T, teicoplanin; V, vancomycin; L, linezolid; Col, colistin; NT, not tested.