Bacterial infection is a common complication in patients with severe alcoholic hepatitis

Background: Alcoholic hepatitis (AH) has a poor short-term prognosis. Although these patients are at high risk of infection, data about sites of infection, pathogen spectrum and effective treatment strategies is lacking.

Methods: 41 cases of severe alcoholic hepatitis (MELD > 20), admitted to the Hepatology Unit of the Hamburg University Medical Center between 2010 and 2014, were analyzed retrospectively by chart review with special focus on demographic, clinical and microbial data as well as treatment outcome.

Results: 39 of 41 patients (95%) received treatment of corticosteroids, whereof 41% (n= 16 of 39) were classified as treatment responder in accordance to the Lille model. Overall mortality was 39% (n= 16 of 41). Infection was observed in 24 patients (61%) of which nine patients (36%) developed infection during treatment with corticosteroids. Mortality was higher when infection occurred during treatment with corticosteroids compared to those cases when infection was diagnosed before treatment with corticosteroids was initiated (55% versus 31%). The most common site of infection was the urinary tract system (n= 14, 56%), followed by positive blood cultures (n= 8, 32%). Enterococcus species were the most frequently identified causative pathogen (42%, n= 9 of 21).

Conclusion: Patients with severe AH are at high risk for infections that correlate with high mortality rates. Infection screening should be mandatory at the time of admission and early antibiotic and potent treatment should be considered, especially in view of the fact that a significant number of infections were not covered by the initial treatment with cephalosporines or chinolones.

Corresponding author: Beisel, Claudia

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