Prevalence, bacterial spectrum and antibacterial susceptibility patterns of urinary tract infections among decompensated Cirrhosis patients in Kiruddu National Referral Hospital.

Abstract

Background: Liver cirrhosis is a major public health problem and a significant cause of morbidity and mortality globally. In 2017 decompensated liver cirrhosis was estimated to affect 10.6 million people globally and 28,877 in Uganda specifically. Bacterial infections are a frequent complication in decompensated cirrhosis. Elsewhere, Urinary tract infection (UTI) is second to Spontaneous Bacterial Peritonitis among commonly identified infections in cirrhosis patients with a prevalence of up to 27%. Uganda currently has no data on the prevalence of UTI in patients with decompensated cirrhosis presenting to health care facilities. In addition, bacterial pathogens and their antibacterial susceptibility profiles are not known especially in this era of increasing antimicrobial resistance. Study objective: To determine the prevalence, associated factors, microbiologic spectrum and sensitivity patterns of bacterial causes of urinary tract infection (UTI) among patients with decompensated liver cirrhosis in Kiruddu National Referral Hospital. Methods: This was a cross sectional study in which patients presenting to the Gastroenterology service of the hospital between from October 2020 to October 2021 were screened for decompensated liver cirrhosis. Eligible patients were subsequently enrolled consecutively, a questionnaire administered and their urine samples collected. Urine samples were subjected to urinalysis and culture studies to determine presence of UTIs and antibacterial susceptibility patterns. Results: The prevalence of UTI in liver cirrhosis was 37.1% (106) on either urinalysis, urine culture or both though only 10.1% (29) of patients were identified on urinalysis and 77 (26.9%) patients were culture positive but had negative urinalysis. The most common bacteria isolated were Enterobactericiae; Eschericia coli (40.1%), Klebsiella pneumoniae (12.1%) and a gram positive Enterococcus spp (22.9%) most of which showed high resistance to the recommended antibiotics for UTI. Multidrug resistant organisms like Extended Beta Lactamase producing bacteria and Methicillin Resistant Staphylococcus Aureus constituted 32.7% of the bacterial isolates. The factors associated with UTI were; female sex (OR 3.3 p=0.0001), Upper Gastrointestinal Bleeding (OR3.0, p=0.012), urinary catheterization (OR 2.5 p=0.05), presence of severe anaemia (OR 2.5, p=0.029) and hypoalbuminaemia (OR 2.6, p =0.010). Conclusion and recommendations: Urinary tract infections are common among patients with decompensated liver cirrhosis, occurring in one third of patients presenting in hospital and are most commonly caused by Enterobactericiae resistant to commonly recommended antibiotics. We therefore recommend screening of all liver cirrhosis patients for UTI at presentation to health care facilities, development of hospital antimicrobial stewardship programs to address the antibacterial resistance.