A Study on Bacterial Infections and their Antimicrobial Susceptibility Pattern in Decompensated Liver Disease Patients in a Tertiary Care Hospital

Rajeswari, J (2015) A Study on Bacterial Infections and their Antimicrobial Susceptibility Pattern in Decompensated Liver Disease Patients in a Tertiary Care Hospital. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Bacterial infections in decompensated liver disease (DCLD) patients are one of the most frequent complications and result in high mortality and morbidity. Patients with DCLD have altered and impaired immunity, which favours bacterial infections. The most common infection in DCLD patients are spontaneous bacterial peritonitis followed by urinary tract infections, Spontaneous bacteraemia, pneumonia, and skin and soft-tissue infections. The prognosis of these patients is closely related to a prompt and accurate diagnosis and appropriate treatment decreases the mortality rates. AIM AND OBJECTIVE: This study was done to determine the various bacterial agents causing infections in decompensated liver disease patients and to determine the drug susceptibility and resistance pattern and to identify their associated risk factors (HBV, HCV) and to estimate the level of C3 component of complement in DCLD patients by ELISA. This study was conducted at the Institute of Microbiology, Madras Medical College, Chennai MATERIALS AND METHODS: About 150 patients (≥18 yrs), admitted in various wards of our hospital with signs & symptoms suggestive of bacterial infections in DCLD patients are included in the study. Ascitic fluid, urine, sputum and wound swab were collected. Blood and serum samples were collected from all the patients and processed according to Standard Microbiological techniques. Detection of HBsAg, Anti HCV ELISA was done according to the manufacturer guidelines to find out the associated risk factors for DCLD and to correlate the bacterial infections with complement C3 level by ELISA. Results: A total of 150 DCLD patients, from September 2013 to August 2014, were included. The common age group involved was 41-60 years, being 97% male. The alcoholic etiology of DCLD was 84%. Out of 150 samples, culture positivity seen in 54% (81/150).In 81 culture positive isolates, 63 (78%) were Gram Negative bacilli and 18 (22%) were Gram Positive cocci, which was correlated significantly [P value = 0.005]. Among 81 culture positive cases, The most common infection in DCLD patients are spontaneous bacterial peritonitis[27%] followed by urinary tract infections[26%], Spontaneous bacteraemia[19%], pneumonia[16%], and skin and soft-tissue infections[12%]. Among Gram negative bacilli, Escherichia coli were the most common isolates and in Gram positive cocci, Staphylococcus aureus was the most common isolates. Most of the organisms were 75% sensitive to amino glycosides and 50% sensitive to fluoroquinolones. All the GNB were 100% sensitive to carbapenem except one carbapenem resistant isolates, Klebsiella oxytoca was isolated from sputum sample. In 81 culture-positive infections, 33[41%] drug resistant bacterial infections were identified: 27 ESBL (81%), 4 Methicillin resistant Staphylococcus aureus (10%) 1 VRE (2.3%), and 1 MBL(2.3%). Of the culture-positive infections, these drug resistant bacterial infections occurred in 11 of 21 (52%) of the UTIs, 8 of 22 (36%) of the SBP, 3 of 15 (20%) of the spontaneous bacteraemia cases, 7 of 13 (54%) of the pneumonia and 4 of 10 (40%) of the skin and soft tissue infection cases. In our study, the prevalence of Hepatitis B surface antigen and Anti hepatitis C virus by serological methods (ELISA) were found to be 8% and 7.3% respectively. Out of 150 total samples, Complement component C3 ELISA was done for randomly selected 88 samples with one kit due to economic constrains. Out of 88 patients, 59 (67%) patients with low complement component C3 level. Of which 35 (59%) patients were culture positive and 24 (41%) were culture negative. 29 (33%) with normal complement component C3 level, of which 25 (86%) were culture negative and 4 (14%) were culture positive. DISCUSSION: In our study, males were commonly involved in DCLD patients due to presence of risk factors like alcoholism. The main causes of DCLD were alcoholic liver diseases. The commonest age group which showed most of the bacterial infections was between 41-50 age groups. The most common and serious bacterial infections in DCLD patients were Spontaneous bacterial peritonitis than other infections. Gram negative bacilli were common isolates than Gram positive cocci. In Gram negative bacilli, E.coli was the main pathogen. High rate of antibiotic resistant isolates were seen in culture-positive infections, with 41% (33 of 81cases). Bacterial infections were associated with low complement component C3 level in DCLD patients. CONCLUSION: The prognosis of these patients is closely related to identify the definitive etiologic diagnosis with its antimicrobial susceptibility and resistant pattern. Antibiotic prophylaxis must be restricted to selected patients and encouraging the use of first line antibiotics and to avoid unnecessary use of higher antibiotics like third generation cephalosporins will help to reduces the occurrence of new resistant strains, which can be significantly reduce hospital stay and morbidity and improve survival rate.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Bacterial Infections ; Antimicrobial Susceptibility Pattern ; Decompensated Liver Disease Patients ; Tertiary Care Hospital.
Subjects: MEDICAL > Microbiology
Depositing User: Punitha K
Date Deposited: 23 May 2018 02:49
Last Modified: 27 May 2018 04:37
URI: http://repository-tnmgrmu.ac.in/id/eprint/8023

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