Infections in Patients with Severe Alcoholic Hepatitis: A Retrospective Study

Abstract

Abstract Introduction Severe alcoholic hepatitis (SAH) is the severest type of alcohol-related liver disease and is fraught with risk of infectious complications. The present study was done to determine the frequency and types of infections noted in patients with SAH at baseline evaluation. Methods This is a retrospective analysis of patients with alcoholic hepatitis treated at our center between 2019 and 2022. Details of age, gender, baseline laboratory parameters, and clinical presentation were noted. All patients were screened for infections to ascertain the suitability for steroid use as per protocol. Diagnosis of infections was done as per the North American Consortium for the Study of End Stage Liver Disease (NACSELD) criteria. In culture-positive infections, the details of the microorganisms that were isolated and antibiotic susceptibility patterns were recorded. Results A total of 66 patients with SAH formed the study cohort (median age: 42 years; 100% males). The majority of them had underlying cirrhosis (33 [50%]) and 26 had acute-on-chronic liver failure. Twenty-eight (42.4%) cases had bacterial infections. Spontaneous bacterial peritonitis (10 [35.7%]) was the commonest infection, followed by urinary tract infection (8 [28.5%]), lower respiratory infections (7 [25%]), and skin infections (3 [10.7%]). Culture positivity was noted in 12 cases (42.9%). The commonest organism cultured was Escherichia coli (6 cases), followed by Klebsiella pneumoniae (cases). Multidrug-resistant (MDR) infections were noted in nine (13.6%) cases. Two patients had tuberculosis. Conclusion In all, 42.4% of patients with SAH had bacterial infections at baseline evaluation. Spontaneous bacterial peritonitis was the commonest infection. MDR bacterial infections were noted in nine cases (13.6%).