Urinary tract infection in non-hospitalized patients with cirrhosis and no symptoms of urinary tract infection: a case series study

Bacterial infections are important factors in decompensation, and they increase the mortality rate of patients with liver cirrhosis. The most common infections among these patients are spontaneous bacterial peritonitis, pneumonia, skin infections and urinary tract infections (UTI). This transversal study evaluated the frequency of UTI in non-hospitalized patients with cirrhosis followed in a hepatology outpatient unit. Patients with clinical, laboratorial, echographic and/or histological diagnosis of cirrhosis were evaluated from April 2002 to August 2004. Patients who accepted participating in this study were submitted to clinical evaluation and the following laboratorial examinations: urine analysis, urine culture, blood culture and hepatic function tests. Patients with symptoms of UTI, diabetis, prostatic disease were excluded. Eighty-two patients with cirrhosis were studied. Their mean age was 51 years (SD = 11); 73 percent were male. Hepatitis C virus was the main etiology in 45 percent of the cases. The Child-Pugh B functional class was observed in 52 percent of the cases. Urine cultures were positive in 4.9 percent of these patients. In this study of non-hospitalized cirrhotic patients, with no symptoms of UTI, the frequency of urinary tract infection was approximately 5 percent. The bacteria found were E. coli and Klebsiella pneumonia. We conclude that it is necessary to screen for UTI in such patients.

Infecção do trato urinário em pacientes cirróticos: revisão sistemática da literatura / Urinary tract infection in cirrhotic patients: systematic review

Introdução: A infecção do trato urinário é uma complicação em pacientes com cirrose. Objetivo: Avaliar a freqüencia de infecção urinária em pacientes cirroticos. Metodologia: Revisão sistemática da literatura utilizando as bases de dados eletronicas (Medline, Embase, Lilacs e Cochrane), abrangendo o período de 1993 a 2004, incluíndo os estudos escritos em inglês, espanhol e português. Resultados: Foram recuperados 135 trabalhos, dos quais 11 estavam de acordo com a metodologia a que se propõe este estudo. A maioria dos casos descritos era de adultos com idade entre 45 e 61 anos, do gênero masculino, tendo o álcool implicado como acusador da cirrose na maioria dos artigos. As classificações de cirrose mais prevalentes segundoo critério Child foram de B e C, e a bactéria mais comum, a Escherichia coli. Conclusão: A maioria dos artigos recebeu classificações baixas quanto à avaliação, sendo demonstrado que não satisfizeram os critérios de sistematização das variáveis