Comparison of mortality in carbapenem resistant gram negative infections in sepsis patients with or without liver cirrhosis: A prospective observational study

Carbapenem-resistant gram-negative bacteria (CRGN) are increasingly recognized as critical pathogens causing severe infections, especially in critically ill patients with sepsis. These multidrug-resistant organisms, including species like Enterobacteriacea, Pseudomonas aeruginosa, and Acinetobacter baumannii, pose significant clinical challenges due to limited therapeutic options and high mortality rates. Sepsis caused by CRGN often leads to prolonged hospitalization, increased healthcare costs, and poor patient outcomes, making early identification and appropriate management vital.

Patients with liver cirrhosis represent a particularly vulnerable population for CRGN infections. Cirrhosis induces systemic immunodeficiency and disrupts the gut-liver axis, promoting bacterial translocation and colonization by multidrug-resistant organisms. This immunocompromised state, coupled with frequent healthcare exposures such as hospital admissions, antibiotic treatments, and invasive procedures, substantially increases infection risk. Bacterial infections in cirrhotic patients frequently precipitate acute decompensation and acute-on-chronic liver failure, conditions associated with high morbidity and mortality. Emerging data indicate that the presence of CRGN infections in cirrhotic patients further worsens outcomes compared to non-cirrhotic individuals, emphasizing the need for focused clinical attention.

Despite the recognized threat, comparative data investigating the clinical features, molecular resistance mechanisms, and patient outcomes of CRGN infections in sepsis with and without cirrhosis remain limited. Understanding differences in mortality, organ dysfunction, and risk factors between these groups is essential to optimize diagnostic and therapeutic strategies. Additionally, characterization of carbapenemase enzymes (e.g., KPC, NDM, VIM, OXA-48, IMP) responsible for resistance can guide effective antimicrobial therapy.

This study aims to prospectively assess 30-day mortality in CRGN infections in sepsis patients with and without liver cirrhosis and to evaluate secondary outcomes including risk factors for infection, resistance patterns, organ dysfunction, ICU/hospital stay duration, and antibiotic susceptibility profiles, ultimately aiming to improve patient management and reduce mortality associated with these challenging infections.