A0492 - 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?

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

KH

Kevin V. Houston, MD

Virginia Commonwealth University Health System
Richmond, VA

Kevin V. Houston, MD¹, Dan Park, MD¹, Nikki Duong, MD¹, Neerav Dharia, MD¹, Jasmohan Bajaj, MD¹, Patrick S. Kamath, MD²
¹Virginia Commonwealth University Health System, Richmond, VA; ²Mayo Clinic, Rochester, MN

Introduction: Cirrhosis patients admitted to the ICU have a high incidence of nosocomial infections that worsens prognosis and can impair liver transplant candidacy. Aim: Determine the impact of COVID-19 restrictions on nosocomial infections in patients with cirrhosis admitted to an ICU a year prior to and during 1 year of COVID-19 restrictions.

Methods: ICU patients with cirrhosis at a transplant center from March 2019-2021 were enrolled and divided into pre-COVID (3/2019-2/2020) and COVID (3/2020-2/2021) eras. From March 2020, masking, hand sanitizations, social distancing, and restriction of visitors were implemented. We excluded patients with both cirrhosis and COVID-19; unclear diagnosis of cirrhosis; and prior organ transplant. Admission demographics and labs, hospital course, reason for ICU transfer, type of infection, nosocomial infections, and outcomes were collected. Logistic regression for nosocomial infection development across time periods was performed.

Results: 530 patients; 234 pre and 296 during COVID era were included.
Patient characteristics: COVID-era patients were younger, had worse cirrhosis severity and qSOFA variables, and higher WBC on admission (Table 1).
Infection characteristics: UTI was higher in COVID-era patients, but other infection types and overall infection rate was similar across periods. There was a significantly lower nosocomial infection rate, patients with >1 organism cultured, MRSA and ESBL (extended spectrum beta-lactamase) production in the COVID-era (Table 1).
Outcomes: COVID-era patients had a higher ICU LOS, renal, and brain failure, but similar death and hospice referrals. Liver transplant rate was higher in COVID-era patients.
Regression for nosocomial infection: The only predictor for nosocomial infection was the study period with lower infections in the COVID-era (OR 0.31, 95% CI 0.14-0.65, p=0.001).

Discussion: Despite a higher qSOFA, MELD-Na and ICU length of stay, the rate of nosocomial and resistant infections with MRSA and ESBL producers was significantly lower in patients with cirrhosis admitted to the ICU in the COVID era compared to the pre-COVID era. This led to a higher liver transplant rate in this setting. This low rate of nosocomial infections could be due to lower transmission of infectious organisms from staff, visitors, and surrounding environment due to the restriction necessitated by the COVID-19 pandemic and should encourage continuation of these restrictions in patients with cirrhosis and intensive care.

	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

Table: Table 1: Data results for pre-COVID era vs COVID-era. 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)

Disclosures:

Kevin Houston indicated no relevant financial relationships.

Dan Park indicated no relevant financial relationships.

Nikki Duong indicated no relevant financial relationships.

Neerav Dharia indicated no relevant financial relationships.

Jasmohan Bajaj indicated no relevant financial relationships.

Patrick Kamath indicated no relevant financial relationships.

Kevin V. Houston, MD¹, Dan Park, MD¹, Nikki Duong, MD¹, Neerav Dharia, MD¹, Jasmohan Bajaj, MD¹, Patrick S. Kamath, MD². A0492 - 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?, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.