Publication

Abstract : Background and Aim: Infections are more common in ESLD and majorly contribute to morbidity and mortality. Limited data from India exists on the bacterial spectrum, and their impact on outcomes of patients with ESLD in critical care setting. This study evaluated spectrum of bacterial infections and antimicrobial resistance patterns in critically ill patients admitted to ILCU and their impact on clinical outcomes. Methods: This was an ambi-spective observational study conducted from January 2023 to January 2025. All patients with ESLD admitted to the ILCU were enrolled. Culture proven infections were identified to determine common bacterial infections, causative bacteria, and their association with the survival. Results: Total 690 patients with end stage liver disease (561 males, 129 females) were included. The leading cause of admission was acute decompensation (36.8%), followed by ACLF (19.79), which also showed significantly higher readmission rates (p=0.001). Sepsis was noted in 83 (11%) patients. Among 288 culture positive isolates, 137 (47.5%) were GNB and 97 (33.6%) GPC. Klebsiella (n=99, 72%) was common Gram negative isolate, Enterococcus (n= 56, 57%) was common Gram positive organism. UTI (n=133) and bacteremia (n=107) were commonly observed. MDROs identified in 105 (36%) cases with CRE (n=61, 58%) and ESBL (n=15, 14%) being predominant. MDROs were linked to higher readmission rates (p=0.045). Prevalence of Candida infections were also prevalent (27.8%). Seven patients were readmitted, five developed MDRO infection. The overall mortality rate was 26%, with sepsis accounting 29% (p=0.05) of deaths. CRE (p=0.02), Candida infections (p=0.002), Circulatory failure (p=0.03), Coagulation failure (p=0.01), Mechanical ventilation (p=0.04), renal replacement therapy (p=0.02) and prior hospitalization (p=0.01) were predictors of mortality. Conclusion: Significant proportion of culture positive infections were due to MDROs, particularly CRE. UTI and bacteremia were most common. Klebsiella and Enterococcus were predominant pathogens. Readmission and mortality were strongly associated with Sepsis, MDRO infections, ACLF, organ failure, and prior hospitalizations.