Analysis Of Clinical Characteristics Of Patients With Decompensated Cirrhosis Complicated With Infection

Objective:This study aimed to analysis the clinical characteristics and pathogenic bacteria of patients with decompensated cirrhosis complicated with infection,to explore the risk factors of infection and the drug resistance spectrum of pathogenic bacteria,and to provide scientific guidance for clinical treatment,so as to improve the poor prognosis of patients with decompensated cirrhosis complicated with infection.Methods:A total of 557 patients with decompensated cirrhosis who were hospitalized in the First Affiliated Hospital of Dali University from January 1,2018 to December 31,2021were retrospectively analyzed.According to the relevant data of patients,they were divided into infected group and non-infected group.The general data of the two groups were compared and analyzed,including basic information,laboratory examination results,complications,infection sites,pathogen composition and drug resistance.SPSS26.0 software was used for statistical analysis.Results:1.Comparison of common data between the infection group and the non-infection group in decompensated cirrhosis:there were significant differences in age,gender,length of hospital stay,etiology of cirrhosis,Child-Pugh classification,invasive operation and combined organ failure between the two groups(P<0.05),there was no significant difference in hypertension and type 2 diabetes between the two groups(P>0.05).2.Comparison of laboratory data between infection group and non-infection group in decompensation stage of liver cirrhosis:WBC,PLT,CRP,TBIL,AST,ALT,PT,INR,SII,NLR levels in infection group were significantly higher than those in non-infection group,while ALB,K~+levels were significantly lower than those in non-infection group(P<0.05).There was no significant difference in Hb,Cr and PLR between the two groups(P>0.05).3.Comparison of clinical complications between infection group and non-infection group during decompensation of liver cirrhosis:the incidence of ascites and hepatic encephalopathy in infection group was significantly higher than that in non-infection group(P<0.05),and there was no significant difference in the incidence of gastrointestinal bleeding between the two groups(P>0.05).4.The results of binary Logistic regression analysis showed that age,Child-Pugh classification and invasive procedure were risk factors for infection in decompensated cirrhosis.5.In the decompensated cirrhosis infection group,the most common infection site was spontaneous bacterial peritonitis(62.2%),followed by pulmonary infection(53.1%),and the infection form was mainly single site infection(72.3%),followed by two site infection(25.2%),three site infection(2.5%).6.Among the patients with decompensated cirrhosis,62 patients had positive specimen culture,and 70 strains were isolated,including 21 strains of Gram-positivebacteria,45 strains of Gram-negative bacteria and 4 strains of fungi.Among the 70 strains isolated,there were 52 resistant strains and 18 non-resistant strains.Gram-negative bacteria were mainly Escherichia coli and Klebsiella pneumoniae,which were sensitive to amikacin,meropenem,imipenem and tigecycline.The resistance rate to the fourth generation antibiotic cefepime was low(4.2%),and the resistance rate toβ-lactam antibiotic ampicillin was high(58.3%).Gram-positive bacteria were mainly Streptococcus pneumoniae and Staphylococcus aureus,sensitive to vancomycin and meropenem,and highly resistant to erythromycin,tetracycline and penicillin.Conclusion:1.The clinical characteristics of patients with decompensated cirrhosis in the infection group and the non-infection group were significantly different,mainly manifested in the higher incidence of ascites and hepatic encephalopathy in the infection group.2.Patients with decompensated cirrhosis are prone to bacterial infection.Spontaneous bacterial peritonitis is the most common,followed by pulmonary infection.3.Age,Child-Pugh classification and invasive operation were risk factors for infection in decompensated cirrhosis.4.Gram-negative bacteria are the main pathogens of co-infection in the decompensated phase of liver cirrhosis,and their drug resistance is characterized by cross-resistance and multidrug resistance.Patients with decompensated phase of liver cirrhosis should try to find pathogenic bacteria,and select the best antibacterial drugs according to the drug sensitivity results to improve the treatment effect.