Five-year Trends of Fungal Infections in Cirrhotic Patients: Nationwide Study From 2016-2020

Abstract

Abstract Background: Patients with cirrhosis are susceptible to infections due to abnormalities in humoral and cell-mediated immunity. Importantly, fungal infections are associated with delayed diagnosis and high mortality rates, emphasizing the importance of performing fungal cultures and maintaining elevated levels of suspicion in this patient population. Methods: This retrospective cohort study analyzes cirrhotic patients readmitted with bacterial and fungal infections and investigates outcomes, including in-hospital mortality and hospital resource utilization. Data was acquired from the Nationwide Readmission Database (NRD) from 2016 to 2020. Results: The study included 393,195 index hospitalizations, with 102,505 30-day and 157,079 90-day readmissions from 2016 to 2020. The number of readmissions for spontaneous bacterial peritonitis (SBP) at 30 days is 8,478 and Spontaneous fungal peritonitis (SFP) is 3,106. The 90-day readmission for SBP is 15,690 and SFP is 5,798. The mean age was 57.9 years. The mean length of stay (LOS) for SBP 30-day readmission is 9.4, while SFP has ranged from 14.9 to 32.3 for various fungal infections, with the highest being Aspergillosis. SFP also has increased hospital charges and mortality rates compared with SBP(P<0.001). Conclusions: It is observed that there is increased mortality, LOS, and hospital costs for SFP compared to SBP. This study emphasized the importance of considering SFP in the diagnostic workup as fungal infections, particularly for patients who do not respond to antibiotic treatment for SBP. Early recognition and administration of antifungals can be associated with improved outcomes in SFP.