Prevalence and risk factors for bacterial skin infection and mortality in cirrhosis

Bacterial infections are often associated with significant morbidity and mortality in cirrhosis. The common practice of outdoor barefoot walking in the developing world may predispose cirrhotic individuals to skin infection. Aims. To determine the prevalence, risk factors, spectrum of infective organism and outcome of bacterial skin infection in cirrhosis. Methods. Consecutive newly diagnosed patients with cirrhosis (n = 200) between September 2007 and September 2008 were studied. Patients with congestive heart failure (n = 50) and chronic kidney disease (n = 50) on follow up at the same institution served as controls. Baseline demographic details, history of outdoor barefoot walking, details of skin infection along with cultures from skin and blood were obtained. The association between patient factors and risk of skin infection was evaluated using logistic regression. Results. Alcoholism was the predominant etiology for cirrhosis. (50%) Most of them were of Child B cirrhosis. Walking on barefoot was found to be similar in cases and controls. 21(10.5%) patients with cirrhosis had skin infection, three fourth of them had a history of barefoot walking. None of the controls had skin infection. Cellulitis with hemorrhagic bullae, leg ulcers, infected callosity and abscess were observed. The infective organism could be isolated in 17 patients. Escherichia coli was the most frequent organism identified. Logistic regression showed outdoor barefoot walking and serum albumin < 2.5 gm/dL as risk factors for skin infection. Four patients died. Conclusion. The prevalence of skin infection in cirrhosis was 10.5% with a mortality of 19%. Escherichia coli was the commonly implicated organism. Outdoor barefoot walking was a strong risk factor for skin infection in cirrhosis.