Urinary tract infections in liver cirrhosis

Abstract

I n t r o d u c t i o n . Bacterial infections are a common pathology in patients with liver cirrhosis (LC) among which urinary tract infections (UTIs) are widely spread. A i m . To study the incidence, features of the course, risk factors of UTIs in hospitalized patients with LC, and the disease prognosis depending on the presence of UTIs.
M a t e r i a l s a n d m e t h o d s . A prospective observational study involving 338 hospitalized patients with LC aged 30 to 84 years (median, 55,00 (45,00; 63,00) years), 189 (55,92%) men and 149 (44,08%) women was conducted. Child-Pugh class A liver cirrhosis was diagnosed in 78 (23,08%) patients, class B – in 118 (34,91%), class C – in 142 (42,01%). Bacterial infections were detected in 172 (50,89%) patients with LC. Clinical examination, clinical investigations and laboratory tests, urine culture with antimicrobial susceptibility testing using conventional microbiological methods were performed in all the patients. 
R e s u l t s . In patients with LC, the incidence of UTIs was 37,87%, and the incidence of asymptomatic bacteriuria – 23,96%. UTIs were more common in women with LC (female to male ratio was 57,81% vs. 42,19%, p < 0,001), in patients with decompensated LC (p < 0,001), and in those with LC duration of less than 5 years (p = 0,016). UTIs co-existed with other infections in 45,31% of cases. In patients with LC, UTIs with systemic manifestations (79,69%), with anatomical and structural changes of the urinary tract according to imaging studies (79%), healthcare-associated infections (44,53%), catheter-associated infections (56,25%), and infections with risk factors (RFs) (94,5%), including more than one RF in 75% of cases, predominated. Among the patients with LC and UTIs 70% died within 45 months of follow-up, which was significantly higher compared to patients without UTIs – 34% (p < 0,001).
C o n c l u s i o n . The high incidence of UTIs in hospitalized patients with LC, the complicated course with the presence of RFs, systemic inflammatory response, co-infections, and the association with an unfavorable prognosis of the disease indicate the need for their timely diagnosis and medical prevention.