Bloodstream infections in patients with liver cirrhosis

Abstract

Bloodstream infections are a serious complication in patients with liver cirrhosis. Dysregulated intestinal bacterial translocation is the predominant pathophysiological mechanism of infections in this setting. For this reason enteric Gram-negative bacteria are commonly encountered as the first etiological cause of infection. However, through the years, the improvement in the management of cirrhosis, the recourse to invasive procedures and the global spread of multidrug resistant pathogens have importantly changed the current epidemiology. Bloodstream infections in cirrhotic patients are characterized by high mortality rate and complications including metastatic infections, infective endocarditis, and endotipsitis (or transjugular intrahepatic portosystemic shunt-related infection). For this reason early identification of patients at risk for mortality and appropriated therapeutic management is mandatory. Liver cirrhosis can significantly change the pharmacokinetic behavior of antimicrobials. In fact hypoproteinaemia, ascitis and third space expansion and impairment of renal function can be translated in an unpredictable drug exposure.

Periodontal status of liver transplant candidates and healthy controls

“…Furthermore, cirrhosis is associated with enhanced pro‐inflammatory response and upregulated expression of cell activation markers . It could be speculated that the immune response impairment, which is associated with greater susceptibility of systemic infections, also plays a role in determining an increased risk for periodontitis. Future studies should evaluate if liver cirrhosis leads to impairment of local immune defenses or increased pro‐inflammatory response to periodontal pathogens.…”

Bacteremia in cirrhotic patients with upper gastrointestinal bleeding

“…As we just discussed, the possible pathophysiology is that advanced patients with cirrhosis are immunocompromised and show dysregulation of intestinal bacterial translocation (20,28). On the other hand, patients with CP classification A are at lower risk to develop bacteremia and mortality in our observation, but in reality, the benefits from the prophylactic antibiotics in these patients are still controversial.…”

“…Moreover, disequilibrium of intestinal bacterial translocation is common in these patients because UGIB exacerbates intestinal barrier function and local immune defense function (28,29). In this setting, endogenous bacteria, such as gram-negative enteric bacilli, anaerobes, and Enterococcus spp.…”

“…In this setting, endogenous bacteria, such as gram-negative enteric bacilli, anaerobes, and Enterococcus spp. from the gastrointestinal tract cause bacteremia by altering the intestinal barrier permeability (28,30).…”

New Case of Endotipsitis: Urgent Need for Clinical Practice Guidelines

“…Enteric bacteria were most frequently encountered as the etiological cause of TIPS infection; however, probably due to the invasive nature of the procedure, bacteria of the skin flora, fungi, and even multidrug resistant pathogens are importantly changing current epidemiology [3,4]. This phenomenon is also observed in any bloodstream infection in patients diagnosed with liver cirrhosis [9]. Including the present case, 18 out of the 56 patients diagnosed with endotipsitis died (to date mortality of 32.1% was noted).…”