Cirrhotic Patients Are at Risk for Health Care–Associated Bacterial Infections

Merli, Manuela; Lucidi, C.; Giannelli, V.; Giusto, M.; Riggio, Oliviero; Falcone, Marco; Ridola, Lorenzo; Attili, Adolfo Francesco; Venditti, Mario

doi:10.1016/j.cgh.2010.06.024

Cited by 284 publications

(282 citation statements)

References 28 publications

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“…The treatment of choice for the most common infections occurring in cirrhosis is third-generation cephalosporins since they are active against Enterobacteriaceae and non-enterococcal streptococci as well as being well tolerated [7][8][9] . However, recent studies have shown that the prevalence of infections caused by multiresistant bacteria is increasing in cirrhosis [10] . Immune defects, mainly acquired but also genetic, and bacterial translocation are the principal mechanism involved in the pathogenesis of infection in cirrhosis [11] .…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and management of bacterial infections in decompensated cirrhosis

Pleguezuelo

Benítez²,

Jurado³

et al. 2013

WJH

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Bacterial infections are one of the most frequent complications in cirrhosis and result in high mortality rates. Patients with cirrhosis have altered and impaired immunity, which favours bacterial translocation. Episodes of infections are more frequent in patients with decompensated cirrhosis than those with compensated liver disease. The most common and life-threatening infection in cirrhosis is spontaneous bacterial peritonitis followed by urinary tract infections, pneumonia, endocarditis and skin and soft-tissue infections. Patients with decompensated cirrhosis have increased risk of developing sepsis, multiple organ failure and death. Risk factors associated with the development of infections are severe liver failure, variceal bleeding, low ascitic protein level and prior episodes of spontaneous bacterial peritonitis (SBP). The prognosis of these patients is closely related to a prompt and accurate diagnosis. An appropriate treatment decreases the mortality rates. Preventive strategies are the mainstay of the management of these patients. Empirical antibiotics should be started immediately following the diagnosis of SBP and the first-line antibiotic treatment is third-generation cephalosporins. However, the efficacy of currently recommended empirical antibiotic therapy is very low in nosocomial infections including SBP, compared to community-acquired episodes. This may be associated with the emergence of infections caused by Enterococcus faecium and extended-spectrum β-lactamaseproducing Enterobacteriaceae, which are resistant to the first line antimicrobial agents used for treatment. The emergence of resistant bacteria, underlines the need to restrict the use of prophylactic antibiotics to patients with the greatest risk of infections. Nosocomial infections should be treated with wide spectrum antibiotics. Further studies of early diagnosis, prevention and treatment are needed to improve the outcomes in patients with decompensated cirrhosis.

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Section: Introductionmentioning

confidence: 99%

Diagnosis and management of bacterial infections in decompensated cirrhosis

Pleguezuelo

Benítez²,

Jurado³

et al. 2013

WJH

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“…[2][3][4] Moreover, the need for frequent exposure to healthcare environment due to the complication of LC, make this population prone to develop healthcare related infections typically characterized by difficult-to-treat and multidrug resistant pathogens. 3,5,6 Infection-related mortality is high in patients with ESLD, approaching 30% within 30 days and 66% within 1 year from the hospital admission. For this reason, infection is considered an important prognostic marker in patients with ESLD.…”

Section: Introductionmentioning

confidence: 99%

Bloodstream infections in patients with liver cirrhosis

et al. 2016

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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.

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“…Recently, an increasing number of cases of SBP due to extended spectrum b-lactamase (ESBL)-producing E. coli, K. pneumonia have been reported in Asia [8][9][10][11] and Europe [12][13][14][15][16]. Some risk factors for SBP caused by ESBL-producing bacteria Enterobacteriaceae have been identified including the in-hospital acquisition of infection [10][11][12][13][14][15], long-term norfloxacin prophylaxis [13], use of blactams within the last 3 months [13], and infection by multiresistant bacteria in the last 6 months [13].…”

mentioning

confidence: 99%

“…Some risk factors for SBP caused by ESBL-producing bacteria Enterobacteriaceae have been identified including the in-hospital acquisition of infection [10][11][12][13][14][15], long-term norfloxacin prophylaxis [13], use of blactams within the last 3 months [13], and infection by multiresistant bacteria in the last 6 months [13]. ESBLproducing strains are resistant not only to third-generation cephalosporins, amoxicillin-clavulanic acid but also to quinolones and trimethoprim-sulfamethoxazole [13].…”

mentioning

confidence: 99%

“…In any case, these findings indicate that international recommendations stating that third-generation cephalosporins or amoxicillinclavulanic acid are the empiric antibiotics of choice for SBP [3] and are inappropriate for SBP episodes caused by ESBL-producing bacteria. Finally, studies have shown that SBP episodes due to ESBL-producing bacteria are more severe than episodes caused by strains sensitive to recommended empiric antibiotics [10][11][12][13][14]. The reasons for the severity of infections due to ESBL-producing bacteria are unknown; theoretically, poor prognosis may be related to a greater severity of the underlying liver disease, higher prevalence of septic shock, or delayed initiation of appropriate antibiotics.…”

mentioning

confidence: 99%

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