The coronavirus disease 2019 (COVID-19) pandemic, caused by the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to significant changes in healthcare systems, such as the introduction of telemedicine. However, these changes have affected patients with a history of chronic conditions.
Recent Scientific Reports The study compares changes in infection patterns in patients hospitalized for cirrhosis before and during the COVID-19 pandemic.
Study: Impact of the COVID-19 pandemic on the frequency and type of infections in hospitalized patients with cirrhosis: A retrospective study. Image credit: Gorodenkoff / Shutterstock.com
Record
Cirrhosis of the liver is a serious condition that leads to scarring of the liver. Typically, patients with cirrhosis are at increased risk of bacterial infections due to their impaired immune system.
In addition, these patients undergo many invasive procedures that increase the risk of bacterial infections. Importantly, these infections increase the risk of developing acute liver failure (ACLF) and mortality.
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 greater risk of developing multidrug-resistant organisms (MDROs), which could ultimately lead to antibiotic resistance and poor outcomes.
The health care system underwent many organizational changes to mitigate the spread of SARS-CoV-2. During the COVID-19 pandemic, healthcare staff have been advised to maintain physical distancing, use telemedicine where available, use hand sanitizer frequently, limit mobility, and use personal protective equipment.
Some of these measures have affected the incidence of bacterial infections, particularly those caused by MDRO. In contrast to the expected decrease in MDRO infections, increased rates of infection have been reported.
About the study
The current retrospective study evaluated whether the COVID-19 pandemic affected the incidence of nosocomial infections and affected MDRO infection rates in patients hospitalized for cirrhosis during the pandemic.
Here, researchers reviewed the medical records of patients aged 18 years and older who were hospitalized for acute decompensated 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 consisting of patients with similar conditions admitted to hospitals between March 11, 2019 and March 10, 2020. The patients who received transplants liver and those infected with SARS-CoV-2 during 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, indicating a low hospitalization rate during the pandemic period.
There was no significant change in the incidence of infection among hospitalized patients with cirrhosis during the pre-pandemic and pandemic periods. However, there was a trend towards lower nosocomial infection. Higher rates of MDRO infection were also observed during the pandemic.
The 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 the prevention and treatment of SARS-CoV-2 infections during the pandemic, with less attention paid to hospital-acquired infections. This could have led to an increase in hospital-acquired infections.
Consistent with previous reports, the current study reported increased urinary tract infections during the pandemic. This increase could be attributed to the lack 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 decreased significantly 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 for the incidence of infection in the study periods.
Despite these limitations, the current study highlights a similar trend in infection frequency in both the 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 should not be avoided, as these measures could lead to an increase in MDRO and hospital-acquired infections.
Journal Reference:
- Cuyàs, B., Huerta, A., Poca, M., et al. (2024) Impact of the COVID-19 pandemic on the frequency and type of infections in hospitalized patients with cirrhosis: A retrospective study. Scientific Reports 14(1); 1-8. doi:10.1038/s41598-024-52452-2
