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Critical Care |

Epidemiology of Infections in Patients With Acute Liver Failure in the Intensive Care Unit

Radhika Zopey, MD; Alexander Zider, MD; Ronak Garg, MD; Scott Hu, MD; Tisha Wang, MD; Jane Deng, MD
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UCLA Medical Center, Los Angeles, CA


Chest. 2013;144(4_MeetingAbstracts):380A. doi:10.1378/chest.1704431
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Abstract

SESSION TITLE: ICU Infections

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 27, 2013 at 10:45 AM - 11:45 AM

PURPOSE: Acute Liver Failure (ALF) is a condition that has been previously noted to predispose patients to various infections. The purpose of this study was to examine the types of infections these patients get, when they typically get infected, and the pathogens that are commonly observed.

METHODS: A retrospective cohort study was conducted on adult patients admitted to a single academic medical center with ALF between 2005-2011. Patients with underlying immunocompromised state (e.g., HIV infection, active malignancy, etc.) were excluded. Data collected included demographic information, co-morbidities, laboratory data, microbiologic data, timing of infections, and survival.

RESULTS: Of the 154 patients in our cohort, 71 (46%) had documented infections with positive cultures. Types of infections included pneumonia (48 patients, 31.2%), bacteremia (15 patients, 9.7%), urinary tract infection (35 patients, 22.7%), and other infections (10 patients, 6.5%). Approximately half of the infections occurred within the first 48 hours of admission. In patients with pneumonia, the most frequent pathogens were gram-negative pathogens along with usual community acquired organisms. Aspergillus species were also cultured in 3 subjects with pneumonia. Increasing Model for End Stage Liver Disease (MELD) score was significantly associated with infection, with odds ratio of 1.13 for each increase in MELD score (p=0.02).

CONCLUSIONS: Results of preliminary analyses demonstrate that pneumonia was the most common infection seen in patients with ALF in the intensive care unit. Although most patients had infections typical of community acquired pathogens, gram-negative bacteria was commonly observed in patients with pneumonia even early on. Collectively, our findings suggest that patients with ALF are susceptible to atypical pathogens, and that the severity of liver failure correlates with the development of infection.

CLINICAL IMPLICATIONS: Understanding the epidemiology and timing of infections among patients with ALF in the intensive care unit may help inform appropriate antibiotic selection for these patients.

DISCLOSURE: The following authors have nothing to disclose: Radhika Zopey, Alexander Zider, Ronak Garg, Scott Hu, Tisha Wang, Jane Deng

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