Reduction in Nosocomial Infections in Patients With Cirrhosis During the COVID-19 Era Compared to Pre-COVID-19 Era: Impact of Masking and Restricting Visitation?

Data results for pre-COVID era vs COVID-era Pre-COVID-era (n=234) COVID-era (n=296) P value Age 58.6 ± 12.2 55.0±13.7 0.001 Male Gender 103 135 0.72 Latin Ethnicity 7 10 0.92 qSOFA total 1.84 ± 0.60 2.43±0.68 < 0.0001 qSOFA respiration 0.12±0.33 0.81±0.39 <0.0001 qSOFA blood pressure 0.93±0.25 0.87±0.34 0.02 qSOFA brain 0.79±0.41 0.75±0.43 0.33 WBC 10.9±7.6 12.5±8.2 0.02 MELD-Na 23.8±10.1 26.0±10.2 0.01 Reason for ICU: Altered Mental Status 117 141 0.59 Infection 115 138 0.56 CVA 12 13 0.69 Hypotension 134 153 0.20 Renal Support 35 88 <0.0001 Respiratory Failure 115 129 0.20 Post-procedure 16 27 0.34 Type of Infection: Nosocomial infection 24 10 <0.001 UTI 11 27 0.05 Abdominal 31 32 0.39 Bacteremia 32 28 0.13 Respiratory 48 57 0.72 Skin/Soft Tissue 10 7 0.22 Organism details: Gram positive 39 36 0.14 Gram negative 31 25 0.08 Fungus 10 12 0.90 > 1 organism 11 5 0.04 VRE 6 5 0.49 MRSA 7 2 0.04 Fluoro resistance 5 2 0.14 ESBL 11 5 0.04 Outcome: ICU length of stay 4.78±4.34 7.66±8.58 <0.0001 Renal Failure 35 83 <0.0001 Grade 3-4 Hepatic Encephalopathy 55 98 0.02 Shock 78 121 0.08 Ventilation 82 115 0.37 Coagulation failure 144 175 0.57 Death or hospice 82 119 0.22 Liver Transplant 6 31 0.001 Key: quick sepsis-related organ failure assessment (qSOFA);white blood cells (WBC);Model for end-stage liver disease-sodium (MELD-Na);intensive care unit (ICU);cerebrovascular accident (CVA);urinary tract infection (UTI);vancomycin resistant enterococcus (VRE);methicillin resistant staphylococcus aureus (MRSA);fluoro (fluroquinolone);extended spectrum beta-lactamase (ESBL).

Reduction in Nosocomial Infections in Patients With Cirrhosis During the COVID-19 Era Compared with Pre-COVID-19: Impact of Masking and Restricting Visitation.

Nosocomial infections (NIs) in critically ill patients with cirrhosis result in higher death and transplant delisting. NIs are promoted by staff, visitors, and the environment, all of which were altered to reduce pathogen transmission after COVID-19. Two cohorts of intensive care unit patients with cirrhosis from March 2019 to February 2020 (pre-COVID, n = 234) and March 2020 to March 2021 (COVID era, n = 296) were included. We found that despite a higher admission MELD-Na, qSOFA, and WBC count and requiring a longer intensive care unit stay, COVID-era patients developed lower NIs (3% vs 10%, P < 0.001) and had higher liver transplant rates vs pre-COVID patients. COVID-era restrictions could reduce NIs in critically ill patients with cirrhosis.