الفهرس 
Cfironic fiver diseasesOnly 14 pages are availabe for public view
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Abstract
Most bacterial infections in cirrhotic patients are hospital acquired. Urinary tract infection
(UTI}, spontaneous bacterial peritonitis (SBP), respiratory tract infection, and bacteremia are the
most frequent bacterial infectious complications seen in cirrhotic patients. The specific risk
factors for infection in cirrhotic patients are low serum albumin, gastrointestinal bleeding,
intensive care unit admission and therapeutic endoscopy. The complement system constitutes an
important component of the defense against foreign organisms functioning in both innate and
adaptive immune system. Serum levels of C3 and C4 are significantly decreased in patients of CLD
mostly due to decreased synthesis and /or increased consumption because of increased CIC.
This study included (90) patients with various causes of CLD (63 with LC and 27 with chronic
hepatitis B or C) that represented different ages (x ± SD= 54.6 ± 9.4) and both sexes (60 males, 30
females) .
All the urine samples were subjected to complete urine analysis, microbiological analysis for
isolation and identification of the causative organisms and then testing the sensitivity of the
isolated organisms to different antimicrobial agents. In addition, serum levels of C3 and C4 were
estimated by RID to evaluate the role of complement in the occurrence of UTI.
Results showed that the mean age of CLD patients was (54 ± 9.8). Males were more commonly
represented in this study than females (66.7o/o).
• Twenty three (out of 29 cases with CLD) had symptoms suggestive of UTI infection.
• The serum levels of AST, ALT, bilirubin, BUN and creatinine were significantly higher while serum
albumin level was significantly lower among CLD patients as compared to controls. Prothrombin time
was significantly prolonged among CLD patients as compared to controls.
• The percent of patients of CLD who had UTI in this study was 32.2%
• Detection of UTI among the studied CLD patients and controls showed that it was more
significantly encountered among CLD and LC patients when compared to the control group. Also, there
was a significant difference between LC and CH.
• The occurrence of UTI among patients with different Child-Pugh classes was significantly higher
when compared to controls. Patients with Child class C had a higher incidence as compared to those
with class A or class B. This result indicates that UTI was more common among patients with more
severe liver disease.
• Patients with UTI had significantly higher levels of pus cells, nitrite and RBCs compared to that
of those without UTI.
• Both C3 and C4 levels were significantly lower among CLD patients with and those without UTI as
compared to that of the controls.
• Serum level of C3 (but not C4) was significantly lower among CLD with UTI when compared to
those without. This finding may indicate . that deficiency of C3 may have a role in the occurrence
of UTI and that it is one of the factors t.hat lead to increased prevalence of UTI among CLD
patients.
• Both C3 and C4 serum levels were significantly lower among LC and CH patients when compared to
the c.ontrols.
• C3 level was significantly higher among patients with Child class A as compared to both class B
and class C patients.
• C4 level was significantly higher among both Child class A and class B patients as compared to
class C patients.
• C3 level was significantly correlated with ALT, AST and PT and C4 level was significantly
correlated with ALT ant PT.
• This study demonstrated that among the isolated causative organisms, E.coli was the most
co111111on; it was isolated from 37.9% of cases, followed by . Staph. saprophyticus (20.7%),
Klebsiella (13.8%), Pseudomonas aeruginosa (10.3%), Strept. faecalis (7.1%) , Staph aureus (3.4%),
Proteus (3.4%) and Candida (3.4%).
• The most effective antibiotic was imipenem which was effective against all the isolated strains.
• .E.coli was mostly sensitive to imipenem, nalidixic acid, norfloxacin, amikacin, pipracillin and
gentamycin.
• Pseudomonas was mostly sensitive to to 1m1penem, amikacin, tobramycin and pipracillin.
• Proteus was mostly sensitive to imipenem, nalidixic acid, norfloxacin, amikin, pipracillin,
tobramycin, ciprofloxacin, gentamycin and trimethoprim-sulphamethoxazole.
· • S. aureus was mostly sensitive to 1m1penem, norfloxacin and ciprofloxacin.
• S. saprophyticus was mostly sensitive to imipenem and norfloxacin.
• Klebsiella was mostly sensitive to imipenem and amikacin.
• Stept. fecalis was mostly sensitive to 1m1penem, amikacin, nitrofurantoin, gentamycin, and
trimethoprim- sulphamethoxazole.