Cellulitis in liver cirrhosis – a series of 25 cases from southern India

Introduction
Cirrhosis of the liver predisposes patients to serious bacterial infections including cellulitis. The aim of the study was to determine the clinical and bacteriological profile of cellulitis in patients with liver cirrhosis.

Material and methods
In this prospective study, consecutive cirrhotic patients hospitalized between February and September 2017 were enrolled. Data retrieved included demographics, aetiology, co-morbidity, cirrhosis-related complications, site of cellulitis, baseline investigations, and wound and blood culture.

Results
Three hundred and thirty-eight patients were admitted, of whom 25 had cellulitis (mean age 52.8 ± 10.4 years, men 88.0%, median MELD [model of end-stage liver disease] 18.8 ± 10.4). Non-alcoholic steato­hepatitis and alcohol were each the cause of cirrhosis in 40% of cases. Nine patients (36%) had diabetes mellitus. Cultures were positive in 13 cases (52%; 1 – blood, 11 – wound, 1 – both blood and skin). The majority of the cultures showed monomicrobial growth (9; 70%). Escherichia coli was the commonest isolate (6/13), followed by Klebsiella (4). 61% of isolates had multidrug resistant organisms. The outcome was favourable.

Conclusions
Prevalence of cellulitis was 7.4% in hospitalised cirrhotics. Culture positivity was 52%. Escherichia coli and Klebsiella were the most common isolates and three fifths of isolates were multidrug resistant.