Cirrhosis patients face mixed infection outcomes amid pandemic healthcare shifts

By Dr. Priyom Bose, Ph.D.Reviewed by Benedette Cuffari, M.Sc.Feb 7 2024

The coronavirus disease 2019 (COVID-19) pandemic, caused by the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), led to significant changes in healthcare systems, such as the introduction of telemedicine. However, these changes have impacted patients with a history of chronic diseases.

A recent Scientific Reports study compares the changes in infection patterns in patients hospitalized due to cirrhosis before and during the COVID-19 pandemic.

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

Background

Cirrhosis of the liver is a severe condition that leads to scarring of the liver. Typically, patients with cirrhosis are at an increased risk of bacterial infections due to their altered immune system.

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

The overuse of antibiotics causes 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 a greater risk of contracting multi-drug resistant organisms (MDRO), which could ultimately lead to antibiotic resistance and poor outcomes.

The healthcare system underwent many organizational changes to mitigate the spread of SARS-CoV-2. During the COVID-19 pandemic, healthcare personnel were advised to follow physical distancing, use telemedicine where applicable, frequently use hand sanitizer, restrict mobility, 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 current retrospective study evaluated whether the COVID-19 pandemic influenced the incidence of nosocomial infections and affected MDRO infection rates in patients hospitalized due to cirrhosis during the pandemic.

Herein, researchers reviewed medical records of patients 18 years of age and older who were hospitalized due to acute decompensation of cirrhosis. Acute decompensation of cirrhosis has been associated with the development of 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-pandemic cohort comprised of patients with similar conditions who were admitted to hospitals between March 11, 2019, and March 10, 2020. Patients who received liver transplants and those infected with SARS-CoV-2 during the time of admission were excluded. 

Study findings

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

No significant change in infection incidence occurred among hospitalized patients with cirrhosis in the pre-pandemic and pandemic periods; however, there was a trend towards a lower nosocomial infection. Higher MDRO infection rates were also observed during the pandemic.

Increased infection rates in hospitalized patients during the COVID-19 pandemic could be attributed to the regular compromise of healthcare services due to the overwhelming pressure of health systems. Most hospital resources were allocated to preventing and treating SARS-CoV-2 infections during the pandemic, with less attention paid to nosocomial infections. This could have led to an increase in nosocomial infections. 

Consistent with previous reports, the current study reported increased urinary tract infections during the pandemic. This increase could be attributed to the shortage of urinary catheter care due to the overwhelming number of patients admitted to hospitals during the COVID-19 pandemic. 

The incidence rates of Clostridioides difficile significantly decreased during the pandemic. In contrast to previous studies, a decrease in MDRO infections was observed in both study periods.

Conclusions

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

Despite these limitations, the current study highlights a similar trend in infection incidence in both pre-pandemic and pandemic periods. However, a lower incidence of nosocomial infections and a higher rate of MDRO infections were observed during the pandemic.

The current study emphasizes that during a pandemic-like crisis, standard infection prevention practices must not be avoided, as these measures could lead to an increase in MDRO infections and nosocomial infections.