Clinical and microbiological characteristics of urinary tract infections in liver cirrhosis

Objective. Analysis of the prevalence, clinical features, and microbiological data of urinary tract infections (UTI) in patients with liver cirrhosis (LC).

Materials and methods. A prospective observational study was conducted on 338 hospitalized patients with liver cirrhosis aged 55.00 (45.00; 63.00) years old, including 189 (55.92%) men and 149 (44.08%) women, with class A – 78 (23.08%), class B – 118 (34.91%), and class C – 142 (42.01%) patients. The study included a microbiological examination of 1,056 urine samples for microbiota and antibiotic sensitivity over a 48-hour period from admission to the hospital organization and after 48 hours of hospitalization. Statistical data processing was performed in the R programming environment. The significance level α is taken to be 0.05. The study was registered in Clinicaltrials.gov (NCT05335213).

Results. The incidence of urinary tract infections is 37.87%, and asymptomatic bacteriuria is 23.96% in hospitalized patients with liver cirrhosis. Urinary tract infections are more commonly diagnosed in women (57.81% vs. 42.19%, p<0.001), in patients with decompensated cirrhosis (p<0.001), and those with a history of liver cirrhosis less than 10 years (p<0.001). Urinary tract infections occur with infections of other localizations in 45.31% of cases. Urinary tract infections with systemic manifestations (79.69%), health-care associated infections (72.66%), catheter-associated infections (56.25%), risk factors (94.5%), and complications (88.94%) prevail in patients with liver cirrhosis. 70% of patients with liver cirrhosis with urinary tract infections had a fatal outcome of the disease within 45 months of follow–up, which is significantly higher than in patients without urinary tract infections – 34% (p<0.001). For patients with urinary tract infection, the immediate risk of death is more than 4 times higher (HR=4.32; 95% CI: 2.88–6.50; p<0.001) compared to individuals without infection. Mixed microbiota of urine was identified in 59 (46.09%) patients. The most common uropathogens were Escherichia coli (36.72%), Enterococcus feacalis (32.81%), and Klebsiella pneumoniae (27.34%). In more than 85% of patients, the isolated strains of Acinetobacter baumanii, Serratia marcencens, Staphylococcus spp., Proteus mirabilis, and Klebsiella pneumoniae were characterized by multiple or extreme resistance to antibacterial drugs.

Conclusion. Urinary tract infections in hospitalized patients with liver cirrhosis have a high prevalence, in most cases have a complicated course, are health-care associated, are associated with an unfavorable prognosis, are characterized by a polymicrobial spectrum of pathogens that belongs to the Pseudomonadota and Bacillota department. The choice of antibacterial drugs should be based on local resistance and be optimized based on the results of drug sensitivity.

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