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

Abstract

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.