Epidemiological investigation of non-fermentative bacterial infection in cirrhotic patients

Background: This study aimed to describe the clinical characteristics of NFGNB in patients with cirrhosis as well as the risk factors for short-term mortality.
Methods: A retrospective analysis was performed in patients with cirrhosis and NFGNB infections from 2011 to 2016 .
Results: 144 episodes in 134 patients with liver cirrhosis and NFGNB infections were found in total. Of these, 81.2% were hospital-acquired or healthcare- associated infections, while only 18.8% of NFGNB infections originated from the community. A. baumannii were the most frequently isolated bacteria (39 episodes), followed by S. maltophilia (38 episodes) and P. aeruginosa (31 episodes). MDR- and non-MDR-NFGNB comprised 62.5% and 37.5% of infections respectively. The Kaplan-Meier survival curve showed no significant difference between MDR and non-MDR NFGNB patients (74.1% vs 75.5%, P = 0.811). Neither MDR or the subgroup of common NFGNB (P. aeruginosa, A. baumannii, S. maltophilia) was associated with the 28-day mortality (all P >0.05). Low albumin levels and high Tbil levels were both independent risk factors for 28-day mortality (HR = 0.930, 95%CI (0.869, 0.995), P = 0.035; HR = 1.003, 95%CI (1.002, 1.005), P < 0.001, respectively).
Conclusions: Diabetes increased 28-day mortality significantly, however, MDR status, site of infection and bacteria type did not.

背景：本研究旨在描述肝硬化患者合并非发酵革兰阴性杆菌（Non-fermenting Gram-negative Bacilli, NFGNB）感染的临床特征，以及短期死亡的相关危险因素。
方法：本研究对2011年至2016年间确诊为肝硬化合并NFGNB感染的患者开展回顾性分析。
结果：本研究共纳入134例患者，共计144次NFGNB感染发作。其中81.2%为医院获得性或医疗保健相关感染，仅18.8%的感染来源于社区。分离菌株中以鲍曼不动杆菌（Acinetobacter baumannii, A. baumannii）最为常见，共计39次发作；其次为嗜麦芽窄食单胞菌（Stenotrophomonas maltophilia, S. maltophilia）（38次）与铜绿假单胞菌（Pseudomonas aeruginosa, P. aeruginosa）（31次）。多重耐药（Multidrug-resistant, MDR）与非多重耐药NFGNB感染分别占总感染次数的62.5%与37.5%。卡普兰-迈耶（Kaplan-Meier）生存曲线分析显示，多重耐药与非多重耐药NFGNB感染患者的生存率无显著差异（74.1% vs 75.5%，P = 0.811）。多重耐药状态以及常见NFGNB亚型（铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌）均与28天死亡率无显著关联（所有P值均>0.05）。低白蛋白水平与高总胆红素（Total Bilirubin, Tbil）水平均为28天死亡率的独立危险因素（风险比HR = 0.930，95%置信区间CI：(0.869, 0.995)，P = 0.035；HR = 1.003，95%CI：(1.002, 1.005)，P < 0.001）。
结论：糖尿病可显著升高28天死亡率，而多重耐药状态、感染部位与菌株类型均无此关联。