Jacqueline G O'Leary1, K Rajender Reddy2, Florence Wong3, Patrick S Kamath4, Heather M Patton5, Scott W Biggins6, Michael B Fallon7, Guadalupe Garcia-Tsao8, Ram M Subramanian9, Raza Malik10, Leroy R Thacker11, Jasmohan S Bajaj12. 1. Medicine, Baylor University Medical Center, Dallas, Texas. Electronic address: Jacquelo@BaylorHealth.edu. 2. Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 3. Medicine, University of Toronto, Toronto, Ontario, Canada. 4. Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota. 5. Medicine, University of California, San Diego, San Diego, California. 6. Medicine, University of Colorado, Denver, Colorado. 7. Medicine, University of Texas Health Science Center, Houston, Texas. 8. Medicine, Yale University School of Medicine, New Haven, Connecticut. 9. Medicine, Emory University, Atlanta, Georgia. 10. Medicine, Beth Israel Deaconess, Boston, Massachusetts. 11. Biostatistics, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia. 12. Medicine, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia.
Abstract
BACKGROUND & AIMS: Bacterial infections, particularly repeated infections, are significant causes of morbidity and mortality among patients with cirrhosis. We investigated and characterized risk factors for repeat infections in these patients. METHODS: In a prospective study, we collected data from 188 patients hospitalized with cirrhosis and infections and enrolled in the North American Consortium for the Study of End-Stage Liver Disease (12 centers). Patients were followed up for 6 months after hospital discharge and data were analyzed on type of infections and factors associated with subsequent infections. RESULTS: Six months after hospital discharge, 14% of subjects had received liver transplants, 27% died, and 59% were alive without liver transplantation. After discharge, 45% had subsequent infections, but only 26% of the subsequent infections occurred at the same site. Compared with patients not re-infected, patients with repeat infections were older and a higher proportion used proton pump inhibitors (PPIs) (P = .006), rifaximin (P < .001), or prophylactic therapy for spontaneous bacterial peritonitis (SBP) (P < .001). Logistic regression showed that SBP prophylaxis (odds ratio [OR], 3.44; 95% confidence interval [CI], 1.56-7.63), PPI use (OR, 2.94; 95% CI, 1.39-6.20), SBP at hospital admission (OR, 0.37; 95% CI, 0.15-0.91), and age (OR, 1.06; 95% CI, 1.02-1.11) were independent predictors of subsequent infections. CONCLUSIONS: Patients hospitalized with cirrhosis and infections are at high risk for subsequent infections, mostly at different sites, within 6 months of index infection resolution. Those at highest risk include previously infected older patients receiving PPIs and/or SBP prophylaxis, although these associations do not prove that these factors cause the infections. New strategies are needed to prevent infections in patients with cirrhosis.
BACKGROUND & AIMS:Bacterial infections, particularly repeated infections, are significant causes of morbidity and mortality among patients with cirrhosis. We investigated and characterized risk factors for repeat infections in these patients. METHODS: In a prospective study, we collected data from 188 patients hospitalized with cirrhosis and infections and enrolled in the North American Consortium for the Study of End-Stage Liver Disease (12 centers). Patients were followed up for 6 months after hospital discharge and data were analyzed on type of infections and factors associated with subsequent infections. RESULTS: Six months after hospital discharge, 14% of subjects had received liver transplants, 27% died, and 59% were alive without liver transplantation. After discharge, 45% had subsequent infections, but only 26% of the subsequent infections occurred at the same site. Compared with patients not re-infected, patients with repeat infections were older and a higher proportion used proton pump inhibitors (PPIs) (P = .006), rifaximin (P < .001), or prophylactic therapy for spontaneous bacterial peritonitis (SBP) (P < .001). Logistic regression showed that SBP prophylaxis (odds ratio [OR], 3.44; 95% confidence interval [CI], 1.56-7.63), PPI use (OR, 2.94; 95% CI, 1.39-6.20), SBP at hospital admission (OR, 0.37; 95% CI, 0.15-0.91), and age (OR, 1.06; 95% CI, 1.02-1.11) were independent predictors of subsequent infections. CONCLUSIONS:Patients hospitalized with cirrhosis and infections are at high risk for subsequent infections, mostly at different sites, within 6 months of index infection resolution. Those at highest risk include previously infected olderpatients receiving PPIs and/or SBP prophylaxis, although these associations do not prove that these factors cause the infections. New strategies are needed to prevent infections in patients with cirrhosis.
Authors: Florence Wong; Jacqueline G O'Leary; K Rajender Reddy; Heather Patton; Patrick S Kamath; Michael B Fallon; Guadalupe Garcia-Tsao; Ram M Subramanian; Raza Malik; Benedict Maliakkal; Leroy R Thacker; Jasmohan S Bajaj Journal: Gastroenterology Date: 2013-08-30 Impact factor: 22.682
Authors: Mohamad A Hanouneh; Ibrahim A Hanouneh; Jana G Hashash; Ryan Law; Jamak Modaresi Esfeh; Rocio Lopez; Nyla Hazratjee; Thomas Smith; Nizar N Zein Journal: J Clin Gastroenterol Date: 2012-09 Impact factor: 3.062
Authors: Javier Fernández; Juan Acevedo; Miriam Castro; Orlando Garcia; Carlos Rodríguez de Lope; Daria Roca; Marco Pavesi; Elsa Sola; Leticia Moreira; Anibal Silva; Tiago Seva-Pereira; Francesco Corradi; Jose Mensa; Pere Ginès; Vicente Arroyo Journal: Hepatology Date: 2012-04-04 Impact factor: 17.425
Authors: Guy W Neff; Michael Jones; Mark Jonas; Ravi Ravinuthala; David Novick; Tiffany E Kaiser; Nyingi Kemmer Journal: J Clin Gastroenterol Date: 2013-02 Impact factor: 3.062
Authors: Francesca Lodato; Francesco Azzaroli; Maria Di Girolamo; Valentina Feletti; Paolo Cecinato; Andrea Lisotti; Davide Festi; Enrico Roda; Giuseppe Mazzella Journal: World J Gastroenterol Date: 2008-05-21 Impact factor: 5.742
Authors: Jasmohan S Bajaj; Jacqueline G OʼLeary; Puneeta Tandon; Florence Wong; Guadalupe Garcia-Tsao; Patrick S Kamath; Scott W Biggins; Jennifer C Lai; Hugo E Vargas; Benedict Maliakkal; Michael B Fallon; Paul J Thuluvath; Ram M Subramanian; Leroy R Thacker; K Rajender Reddy Journal: Am J Gastroenterol Date: 2019-07 Impact factor: 10.864
Authors: Jasmohan S Bajaj; Rajender K Reddy; Puneeta Tandon; Florence Wong; Patrick S Kamath; Scott W Biggins; Guadalupe Garcia-Tsao; Michael Fallon; Benedict Maliakkal; Jennifer Lai; Hugo E Vargas; Ram M Subramanian; Paul Thuluvath; Leroy R Thacker; Jacqueline G OʼLeary Journal: Am J Gastroenterol Date: 2017-12-19 Impact factor: 10.864
Authors: Jasmohan S Bajaj; K Rajender Reddy; Puneeta Tandon; Florence Wong; Patrick S Kamath; Guadalupe Garcia-Tsao; Benedict Maliakkal; Scott W Biggins; Paul J Thuluvath; Michael B Fallon; Ram M Subramanian; Hugo Vargas; Leroy R Thacker; Jacqueline G O'Leary Journal: Hepatology Date: 2016-02-19 Impact factor: 17.425
Authors: Sara Blasco-Algora; José Masegosa-Ataz; María Luisa Gutiérrez-García; Sonia Alonso-López; Conrado M Fernández-Rodríguez Journal: World J Gastroenterol Date: 2015-11-14 Impact factor: 5.742