High Mortality With Non-O1/Non-O139 Vibrio cholera Bacteraemia in Patients With Cirrhosis

• Published in: Journal of clinical and experimental hepatology 2024-05, Vol.14 (3), p.101346-101346, Article 101346
• Main Authors: Singh, Kunwar A., Anandan, Shalini, Sharma, Anand, Kumar, Santhosh E., Solaimalai, Dhanalakshmi, Veeraraghavan, Balaji, Goel, Ashish, Eapen, Chundamannil E., Zachariah, Uday G.
• Format: Article
• Language: English
• Subjects: bacterial infection; cirrhosis; Escherichia Coli; non-extended spectrum beta lactamase (ESBL); non-O1/non-139 Vibrio cholera; spontaneous bacterial peritonitis
• ISSN: 0973-6883; 2213-3453
• DOI: 10.1016/j.jceh.2024.101346

Data on non-O1/non-O139 Vibrio cholera (NOVC) infection in liver disease is limited. We studied the clinical features and outcome of patients with cirrhosis with non-NOVC bacteraemia and/or spontaneous bacterial peritonitis (SBP) when compared to non-extended spectrum beta lactamase (non-ESBL) Escherichia coli (E. coli). Hospital information system of patients with cirrhosis admitted with bacteraemia and/or SBP from 2010 to 2020 was searched to include patients with NOVC infection. Non-ESBL E. coli bacteraemia/bacterascites were chosen as a comparator group, matched for the date of admission within 5 days of index case. Propensity score matching (PSM) was done for patient's age and Child score to compare outcome at discharge between NOVC-infected and E. coli–infected cirrhotic patients. There were 2545 patients admitted with bacteraemia and/or SBP during the study period; 29 had NOVC isolated (M:F = 23:6; age: 39, 18–54 years; median, range; model for end-stage liver disease [MELD] score: 25, 12–38; Child score: 11, 10–12.5) from either blood (26), ascites (3), or both (8). Of these, 26 isolates were pan-sensitive to antibiotic sensitivity tests. Fifty-three patients with non-ESBL E. coli were isolated (M: F = 43:10; age: 48; 18–69 years; MELD score: 25, 20–32; Child score:12,11–13) from blood (31), ascites (17), or both (5) within the selected time frame. Of these, 48 isolates were sensitive to the empirical antibiotics initiated. After PSM, in comparison with 29 non-ESBL E. coli patients (age: 41, 18–55 years; MELD score: 24, 19–31; Child score: 12, 11–13), NOVC patients had higher incidence of circulatory failure at admission (14 [49 %] vs 4 [13 %]; P: 0.01) and significantly higher in-hospital mortality (15 [52 %] vs 6 [20 %];P: 0.028]. Bacteraemia due to non-O1/non-O139 strains of V. cholera, is an uncommon cause of bacteraemia or bacterascites in patients with cirrhosis and is associated with high incidence of circulatory failure and significant mortality. [Display omitted]