Epidemiology of ascites fluid infections in patients with cirrhosis in Queensland, Australia from 2008 to 2017: A population-based study - PubMed (original) (raw)

Observational Study

Epidemiology of ascites fluid infections in patients with cirrhosis in Queensland, Australia from 2008 to 2017: A population-based study

Isanka U Ratnasekera et al. Medicine (Baltimore). 2022.

Abstract

Spontaneous bacterial peritonitis (SBP), a common infection in patients with cirrhosis and ascites, is associated with high morbidity and mortality. The aim of this study was to investigate changes in the epidemiology of ascites fluid infections over time in an Australian population, including patient demographics, trends in mortality, length of hospital stay and the nature and antibiotic resistance profile of causative organisms.An observational descriptive population-based epidemiological study of patients with cirrhosis admitted to public hospitals in Queensland during 2008-2017 was performed, linking demographic/clinical and microbiology data.Among 103,165 hospital admissions of patients with cirrhosis, ascites was present in 16,550 and in 60% (9977) a sample of ascitic fluid was tested. SBP was diagnosed in 770 admissions (neutrophil count >250/ml) and bacterascites in 552 (neutrophil count <250/ml with positive culture). The number of admissions with an ascites fluid infection increased by 76% from 2008 to 2017, paralleling an 84% increase in cirrhosis admissions over the same timeframe. Patients with SBP had a longer hospital stay (median 15.7 vs 8.3 days for patients without SBP, P < .001) and higher in-hospital mortality, although this decreased from 39.5% in 2008 to 2010 to 24.8% in 2015 to 2017 (P < .001). Common Gram-positive isolates included coagulase negative staphylococci (37.9%), viridans group streptococci (12.1%), and Staphylococcus aureus (7.2%). Common Gram-negative isolates included Escherichia coli (13.0%), Klebsiella pneumoniae (3.1%) and Enterobacter cloacae (2.6%). The prevalence of resistance to any tested antibiotic was <10%.SBP remains associated with high in-hospital mortality and long hospital stay. Typical skin and bowel pathogens were common, therefore, empirical antibiotic therapy should target these pathogens. This study provides valuable evidence informing infection management strategies in this vulnerable patient population.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1

Summary of study cohort.

Figure 2

Aetiology of cirrhosis for ascites cohort (16,550 admissions). Number of admissions with listed ICD codes as primary diagnosis or co-factor (for etiologies with >50 admissions over the study period). Admissions may be associated with more than one code. ∗ICD K769, K753, K759, #ICD K746.

Figure 3

Ascites admissions, infection rate and outcomes. A. Classification of admissions with an ascitic fluid sample based on the neutrophil (PMN) count and culture positivity. B. Proportions of total cirrhosis admissions with ascites, ascites fluid samples, SBP and bacterascites per study year. C. Length of hospital stay and D. In–hospital mortality in SBP-positive and -negative admissions.

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Epidemiology of ascites fluid infections in patients with cirrhosis in Queensland, Australia from 2008 to 2017: A population-based study - PubMed (original) (raw)