Comparison of Bacterial Infections in Patients With Cirrhosis Between Hospitals With and Without Liver Transplant in Catalonia.

BACKGROUND AND AIMS: Infections by multidrug resistant (MDR) bacteria are increasing and vary across regions and hospitals. We aimed to assess the epidemiology, prevalence, and outcomes of bacterial infections in patients with decompensated cirrhosis, comparing liver transplant (LT) and non-LT centers in Catalonia.

METHODS

This is a multicenter retrospective study including all patients with decompensated cirrhosis and bacterial infections hospitalised between January 2021 and 2022 from 5 university hospitals in the Barcelona metropolitan area. Two of them were LT centres. Clinical, laboratory, microbiological data, and in-hospital mortality were collected.

RESULTS

A total of 576 infections were reported in 352 patients. LT centers had more health-related infections, recurrent infections, and septic shock than non-LT centers, while there were no differences in cirrhosis severity, acute-on-chronic liver failure (ACLF) or comorbidities. Although the most commonly isolated microorganisms and types of infection were similar in both centers, LT centers had higher rates of extended-spectrum beta-lactamase (12% vs. 6%), carbapenem (3% vs. 0%) and piperacillin-tazobactam resistant bacteria (14% vs. 7%). MDR rate was also higher in LT centers (38% vs. 25%, p = 0.02) and varied across hospitals (18%-42%, p < 0.05). Furthermore, in-hospital mortality was higher in LT centers (20% vs. 10%; p = 0.01). Independent predictors of in-hospital mortality were septic shock, ACLF, Child-Pugh, age, and leukocyte count.

CONCLUSIONS

Our study showed differences in epidemiology, prevalence of MDR infections, and outcomes across university hospitals, particularly between centers with and without LT. Further studies are warranted to unveil the nuances of bacterial infections across different healthcare institutions in Europe and elsewhere.