Abstract: Objective To investigate the clinical features, pathogenic features and influencing factors of hepatitis B-related end-stage liver disease (ESLD) complicated with infection. Methods A total of 82 patients with hepatitis B-related ESLD were selected between January 2017 and June 2022, including 51 males and 31 females with an age of 45(34, 60) years. Among them, 34 were not complicated with infection (non-complicated infection group), while 48 were complicated with infection (complicated infection group). The selected ESLD cases met the diagnostic requirements. Single-factor and multi-factor analyses were conducted to analyze the influencing factors of complicated infection in ESLD patients, and information such as infection location, pathogen specimen source, and culture results were collected. Results Univariate analysis indicated that the WBC, CRP, ALT, AST, TBil, Scr, INR, PCT and MELD scores in the complicated infection group were 6.8(4.4, 11.3) ×10⁹/L, 35.8(17.3, 43.8) mg/L, 92(70, 123) U/L, 102(78, 140) U/L, 127.0 (73.8, 250.4) μmol/l, 92.7 (65.5,112.3) μmol/l, 2.0 (1.4,2.3), 6.2 (2.0,9.0) ng/l and 14 (9, 22) points, which were significantly higher than those in the non-complicated infection group [3.7 (3.0, 5.3 ) ×10⁹/L, 11.2 (7.6, 18.9) mg/L, 57 (18, 88) U/L, 54 (24,79) U/L, 37.3(17.9, 80.2) μmol/l, 74.2 (44.8, 97.0) μmol/l, 0.9 (0.7, 1.2), 0.2 (0.1, 2.8) and 7 (5, 11) points, P<0.05]. Additionally, the Alb and PTA levels in the complicated infection group were 28.3(27.8, 31.6) g/L and 45.3(37.9, 50.8) %, which were significantly lower than those in the non-complicated infection group [33.2(30.8, 35.8)g/L and 66.7(49.6, 74.0)%, P<0.05]. In the complicated infection group, 37 cases (77.1%) had single infections and 11 cases (22.9%) had multiple infections. Among the patients with a single infection site, the most common infection was SBP in 18 cases (37.5%), followed by lung infection in 13 cases (27.1%), urinary tract infection in 4 cases (8.3%), and biliary tract infection in 2 cases (4.2%). For patients with multiple infection sites, the most common scenario was SBP combined with lung infection in 10 cases (20.8%), and SBP combined with fungal infection in 1 case (2.1%). A total of 16 pathogens (33.3%) were cultured among the 48 patients, including 9 strains of Bacillus (56.2%), 6 strains of cocci (37.5%) and 1 strain of fungi (6.2%). The bacterial isolates consisted of 7 strains of Escherichia coli (43.7%), 1 strain of Klebsiella pneumoniae (6.2%) and 1 strain of Klebsiella acidogenes (6.2%). Staphylococcal isolates comprised 5 strains of Enterococcus faecalis (31.2%) and 1 strain of Staphylococcus aureus (6.2%). Additionally, there was 1 strain of Candida albicans (6.2%) among the fungal isolates.The resistance rates of Escherichia coli to quinolones such as levofloxacin and ciprofloxacin were 57.1%(4/7) and 42.8%(3/7), respectively, while the resistance rate to cefuroxime was 71.4%(5/7). Escherichia coli exhibited sensitivity to carbapenems such as cefoperazone, sulbactam, meropenem and imipenem. The resistance rate of Enterococcus faecalis to penicillin, levofloxacin and ciprofloxacin were all 80.0%(4/5). Additionally, the resistance rate to tetracycline, gentamicin and streptomycin were 20.0%(1/5), 40.0%(2/5) and 60.0% (2/5), respectively. Conclusion Effective antibiotic treatment plans should be developed for ESLD patients with infections based on the complicated infection site, past antibiotic use history, combined with the epidemic spectrum of pathogenic bacteria and the detection and analysis of drug resistance. This approach will help to prevent further aggravation of infection.

Key words: End-stage liver disease, Bacterial infection, Spontaneous bacterial peritonitis