Fungal urinary tract infection among chronic liver disease patients with hepatic encephalopathy and its treatment outcomes

BACKGROUND AND AIM: Patients with chronic liver disease (CLD) are at high risk of infections, including fungal pathogens, which can lead to hepatic encephalopathy (HE) and increased mortality. Our aim is to evaluate the frequency and outcome of fungal urinary tract infections (FUTIs) in hospitalized patients with CLD and HE. METHODS: This was a descriptive case series study using the nonprobability consecutive sampling technique, conducted at the Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. All patients above 18 years of age who were admitted with HE and CLD were enrolled after obtaining informed consent. Baseline laboratory investigation, urine detail report (UDR), and culture were sent on the day of admission. Fluconazole was started if the UDR reported yeast positivity. Data were analyzed using SPSS version 25. RESULTS: A total of 236 patients were enrolled in this study. Mean age was 53.42 ± 5.567 years, and 95 (40.3%) were male. Urinary symptoms were present in 72 (30.5%) patients. Yeast positivity on UDR was present in 156 (66.1%), and 141 of 156 (90.3%) patients had urine culture positivity for fungal pathogen. A total of 55 patients died—36 (65.5%) in the FUTI group and 19 (34.5%) in the nonfungal UTI (NFUTI) group (P = 0.908). Candida albicans was the most common organism, present in 70 of 141 (49.6%) of patients. Predictors of mortality were renal insufficiency, hyperkalemia, hyponatremia, leukopenia, and advanced cirrhosis. CONCLUSION: FUTI in CLD patients with HE is common in hospitalized patients even without symptoms, and a high index of suspicion is required. Candida albicans was the most common organism. Prompt recognition and treatment can improve overall outcome.