Cirrhosis patients face mixed infection outcomes amid pandemic healthcare shifts

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The coronavirus disease 2019 (COVID-19) pandemic, due to the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to significant changes in the healthcare system, such as the introduction of telemedicine. However, these changes affected patients with a history of chronic disease.

recent Scientific report The study compared changes in infection patterns in patients hospitalized for cirrhosis before and during the Covid-19 pandemic.

Study: Impact of the COVID-19 pandemic on the incidence and types of infections in hospitalized patients with cirrhosis: a retrospective study.  Image credit: Gorodenkoff/Shutterstock.com Study: Impact of the COVID-19 pandemic on the incidence and types of infections in hospitalized patients with cirrhosis: a retrospective study. Image credit: Gorodenkoff / Shutterstock.com

Background

Cirrhosis of the liver is a serious condition that causes scarring of the liver. Generally, patients with cirrhosis are more prone to bacterial infections due to their altered immune system.

Furthermore, many of these patients undergo invasive procedures that increase their risk of bacterial infection. Importantly, these infections increase the risk of acute-on-chronic liver failure (ACLF) and death.

Overuse of antibiotics leads to antibiotic resistance. It is considered a significant threat to the global population, as patients with antibiotic-resistant infections often do not respond to available antibiotics. Several studies have shown that patients with cirrhosis are at increased risk of developing multi-drug resistant organisms (MDRO), which can ultimately lead to antibiotic resistance and poor outcomes.

Many organizational changes have taken place in the health care system to reduce the spread of SARS-CoV-2. During the COVID-19 pandemic, health care workers were advised to follow physical distancing, use telemedicine where applicable, use hand sanitizer frequently, limit movement, and use personal protective equipment.

Some of these measures have influenced the incidence of bacterial infections, particularly those caused by MDRO. In contrast to the expected decrease in MDRO infections, increased infection rates have been recorded.

About the study

The present retrospective study evaluated whether the Covid-19 pandemic affected the incidence of nosocomial infections and MDR infection rates in patients hospitalized for cirrhosis during the pandemic.

Here, researchers reviewed the medical records of patients 18 years of age and older who were hospitalized for acute exacerbations of cirrhosis. Acute exacerbations of cirrhosis have been associated with hepatic encephalopathy (HE), ascites, gastrointestinal (GI) bleeding, or bacterial infection.

All patients were hospitalized between March 11, 2020 and March 10, 2021. The medical records of these patients were compared with a pre-epidemic cohort consisting of similar patients who were hospitalized between March 11, 2019, and March 10, 2020. Patients who underwent liver transplantation and patients infected with SARS-CoV-2 during admission were excluded. was given

Study results

During the pre-epidemic period, a total of 170 patients were hospitalized for acute exacerbations of cirrhosis 251 times. During the epidemic period, 114 patients were hospitalized 169 times for similar conditions, thus indicating a low hospitalization rate during the epidemic period.

There was no significant change in the incidence of infection among hospitalized patients with cirrhosis during the pre-epidemic and epidemic periods; However, there was a trend towards a lower nosocomial infection. Higher MDRO infection rates were also observed during epidemics.

Regular compromise of healthcare services due to overwhelming pressure on the health system can be attributed to increased infection rates among hospitalized patients during the COVID-19 pandemic. While most hospital resources were devoted to preventing and treating SARS-CoV-2 infections during the pandemic, less attention was paid to nosocomial infections. It may cause increase in nosocomial infections.

Consistent with previous reports, the current study reported an increase in urinary tract infections during the epidemic. This increase can be attributed to shortage of urinary catheter care due to excessive number of hospitalized patients during the COVID-19 pandemic.

Its incidence rate Clostridium difficile has declined significantly during the pandemic. In contrast to previous studies, a decrease in MDRO infections was observed during both study periods.

Conclusion

The current study has some limitations, including its retrospective design and relatively small sample size. The low sample size may have contributed to the lack of statistical significance in the incidence of infection during the study period.

Despite these limitations, the present study highlights similar trends in infection incidence during both pre-epidemic and epidemic periods. However, a low incidence of nosocomial infections and high rates of MDRO infections were observed during the epidemic.

The present study emphasizes that during a crisis such as an epidemic, standard infection prevention practices should not be avoided, as these measures may lead to an increase in MDRO transmission and nosocomial infections.

Journal Reference:

  • Cuyàs, B., Huerta, A., Poca, M., etc (2024) Impact of the COVID-19 pandemic on the incidence and types of infections in hospitalized patients with cirrhosis: a retrospective study. Scientific report 14(1); 1-8. doi:10.1038/s41598-024-52452-2



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