Photo Credit: Peddalanka Ramesh Babu

The following is a summary of “Hospital-acquired bloodstream infections in critically ill cirrhotic patients: a post-hoc analysis of the EUROBACT-2 international cohort study,” published in the May 2024  issue of Critical Care by Wozniak et al.

Patients with cirrhosis in ICUs experience distinct hospital-acquired bloodstream infections, potentially including more gram-positive and enterococcal infections.

Researchers conducted a retrospective study to investigate and compare the epidemiology of hospital-acquired bloodstream infections in patients with cirrhotic vs. non-cirrhotic admitted to the ICU, focusing on infection sources, causative microorganisms, and associated mortality.

They examined the sources and microorganisms responsible for hospital-acquired bloodstream infections in patients with and without cirrhosis. A multivariable mixed logistic regression investigated the association between Enterococcus faecium and cirrhosis. Additionally, the relationship between cirrhosis and mortality was evaluated using a multivariable frailty Cox model.

The results showed that of 1,059 patients from 101 centers with nosocomial infection, 160 had cirrhosis. In patients with cirrhosis, gram-positive hospital-acquired bloodstream infections (HABSIs) accounted for 42.3% of cases, while non-cirrhosis controls had 33.2% (P=0.02). The most common infection for patients with cirrhosis was abdominal (35.6%), whereas for non-cirrhotic controls, it was pulmonary (18.9%) (P<0.01). The most frequent pathogens causing infections in cirrhotic controls were Klebsiella spp (16.5%), coagulase-negative Staphylococci (13.7%), and E. faecium (11.5%). E. faecium bacteremia occurred more frequently (11.5% versus 4.5%, P<0.01). Patients with cirrhosis also experienced higher mortality compared to patients without cirrhosis (Hazard Ratio 1.3, 95% CI 1.01–1.7, P=0.045).

Investigators concluded that critically ill patients with cirrhosis and hospital-acquired bloodstream infections showed different epidemiology by a higher prevalence of Gram-positive infections, especially Enterococcus faecium.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01299-x