• Michele Bartoletti, Maddalena Giannella, Paolo Caraceni, Marco Domenicali, Simone Ambretti, Sara Tedeschi, Gabriella Verucchi, Lorenzo Badia, Russell E Lewis, Mauro Bernardi, and Pierluigi Viale.
• Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
• J. Hepatol. 2014 Jul 1;61(1):51-8.

Background & AimsBloodstream infections (BSIs) in cirrhotic patients are 10-fold more common than in non-cirrhotic patients and increasingly caused by resistant pathogens. We examined 162 BSI episodes in cirrhotic patients to describe the etiology and risk factors for 30-day mortality.MethodsWe retrospectively analyzed all consecutive BSIs in patients with liver cirrhosis at our 1350-bed teaching hospital (January 2008 to June 2012). Cox-proportional hazard regression was used to analyze the impact of disease and treatment-related variables on the crude 30-day mortality.ResultsBSI episodes were identified in 162 patients, including 29 mixed infections. Most of episodes were classified as hospital acquired or healthcare associated (93%). Gram-negative bacteria (GNB), Gram-positive bacteria and Candida spp. caused 64%, 38%, and 10% of episodes, respectively. GNB were classified as multi-drug resistant (MDR) and extensively drug resistant (XDR) in 25% and 21% of cases, respectively. The overall crude 30-day mortality rate was 29%. Four risk factors were independently associated with 30-day crude mortality: worsening of MELD score from baseline (the last MELD score available in the 2 weeks prior BSI) to that at BSI onset (HR 1.11 per point increase, 95% CI 1.07-1.15, p<0.0001), spontaneous bacterial peritonitis as BSI source (HR 4.42, 2.04-9.54, p=0.002), sepsis grading (HR 2.18, 1.39-3.43, p=0.0007), and inappropriate antibiotic therapy within 24h from blood cultures (HR 2.82, 1.50-5.41, p=0.002).ConclusionAn increasing proportion of BSIs in cirrhotic patients are caused by resistant GNB and Candida spp. Accurate evaluation of risk factors for mortality may improve early appropriate therapeutic management.Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

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