Dr. Rios Fernández, <i>et al,</i> reply

Fernández, Raquel Ríos; Callejas‐Rubio, José Luis; Fernández-Roldán, Concepción; Centeno, Norberto Ortego

doi:10.3899/jrheum.110884

Cited by 9 publications

(24 citation statements)

References 8 publications

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“…Moreover, the latest study showed that nearly half of ACLF patients without infections developed BIs during hospitalization compared with those with acute decompensation of cirrhosis (46% vs. 18%); the main clinical types of BIs in ACLF were SBP, UTIs, and pneumonia. 14…”

Section: A Complication: Bis Complicating Aclfmentioning

confidence: 99%

“…2,6 The diagnostic criteria for pneumonia are also controversial, because there are no exact items for a diagnostic standard. 7,14,62 Importantly, although a positive bacterial culture is regarded as the gold standard, the culture rate is low, and more than half of infections in cirrhosis are culture-negative. 6,63 Hence, the development of new diagnostic methods for the early identification of BIs is crucial.…”

Section: Diagnostic Criteriamentioning

confidence: 99%

“…ACLF patients with BIs showed higher WBC counts (9.9Â10 9 /L vs. 6.8Â10 9 /L) and 90-day mortality rates (51% vs. 38%) than patients without BIs. 14 As a complication, BIs are also associated with a poor ACLF prognosis. As previously reported, 23 ACLF patients with bacteremia had more intensive support, higher Model for End-Stage Liver Disease scores, greater degrees of encephalopathy, and lower survival rates than ACLF patients without bacteremia.…”

Section: Prognosismentioning

confidence: 99%

“…Although the definitions of ACLF are controversial, BIs have been proven to play pivotal roles in the development and progression of ACLF. 7,9,[12][13][14] Some studies have demonstrated that BIs are a common precipitating event not only in ACLF caused by non-HBV etiologies (non-HBV-ACLF) 7,9 but also in HBV-ACLF. 11,15 However, the prevalence, characteristics, and prognostic impacts of BIs in HBV-ACLF are unclear.…”

mentioning

confidence: 99%

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Bacterial Infections in Acute-on-Chronic Liver Failure

Yang

Jiang

et al. 2018

Semin Liver Dis

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Acute-on-chronic liver failure (ACLF) is a newly recognized clinical syndrome characterized by preexisting chronic liver disease or cirrhosis with organ failure and high 28-day mortality (50-90%). Bacterial infections (BIs) play pivotal roles in the development and progression of ACLF either as a main precipitating event or a specific complication. The main organisms isolated as triggering ACLF are Gram-positive bacteria, followed by Gram-negative bacteria. Spontaneous bacterial peritonitis, pneumonia, urinary tract infections, and skin infections are prevalent infections that trigger and complicate ACLF. Despite appropriate antibiotic treatment, BIs account for poor ACLF outcomes and lead to a worse clinical course and higher intensive care unit admission and short-term mortality. Early diagnosis and novel nonantibiotic methods are highly important for managing BIs. Thus, this review focuses on the epidemiology, prognosis, and diagnosis of and management strategies for BIs in ACLF patients as well as the relationship between BIs and ACLF.

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Section: A Complication: Bis Complicating Aclfmentioning

confidence: 99%

Section: Diagnostic Criteriamentioning

confidence: 99%

Section: Prognosismentioning

confidence: 99%

mentioning

confidence: 99%

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Bacterial Infections in Acute-on-Chronic Liver Failure

Yang

Jiang

et al. 2018

Semin Liver Dis

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“…63 Likewise, in chronic end-stage liver disease, when KCmediated barrier function is diminished, patients are prone to developing bacterial and fungal infections representing a major trigger of acute-on-chronic liver failure. 64,65 Clearly, liver resident KCs are critical in maintaining important innate immunity and are fundamentally implicated in the pathology of liver disease.…”

Section: Role Of Macrophages In Liver Diseasementioning

confidence: 99%

Macrophages as a Cell-Based Therapy for Liver Disease

2019

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Liver failure arising from acute and chronic liver disease is an unmet clinical need that urgently requires novel therapeutic options in addition to orthotopic liver transplantation. Cell therapies offer new strategies to recover liver function through the reconstitution of healthy parenchyma and resolution of tissue pathology. Macrophages are professional phagocytes that comprise a key part of the innate immune system providing an important defense mechanism against invading pathogens. Macrophages are an inherently diverse cell type with respect to ontogeny, tissue distribution, phenotype, and function. The ability of macrophages to afford innate immunity, efficiently scavenge apoptotic/necrotic cells, and modulate local tissue microenvironment makes them an attractive cell therapy candidate for various diseases. This review aims to outline the rationale and utility of macrophages to serve as a potential cell therapy for liver disease.

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Management of Multidrug-Resistant Infections in Cirrhosis

Gallaher

Shawcross

2022

Semin Liver Dis

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The World Health Organization describes antimicrobial resistance (AMR) as one of the biggest threats to global health, food security, and development with indiscriminate use of antimicrobials globally driving the emergence of multidrug-resistant bacteria, resistant to 60% of antimicrobials in some countries. Infections with multi-drug resistant organisms (MDROs) have increased in recent decades in patients with cirrhosis, who are frequently prescribed antibiotics, regularly undergo invasive procedures such as large volume paracentesis and have recurrent hospitalizations, posing a particular risk in this already immunocompromised cohort of patients. In this review, we explore mechanisms underlying this vulnerability to MDRO infection; the effect of bacterial infections on disease course in cirrhosis; prevalence of MDROs in patients with cirrhosis; outcomes following MDRO infection; fungal infections; antibiotics and their efficacy; and management of MDRO infections in terms of detection, antimicrobial and non-antimicrobial treatments, prophylaxis, antibiotic stewardship, the gut microbiome, and technological interventions.

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Dr. Rios Fernández, et al, reply

Cited by 9 publications

References 8 publications

Bacterial Infections in Acute-on-Chronic Liver Failure

Bacterial Infections in Acute-on-Chronic Liver Failure

Macrophages as a Cell-Based Therapy for Liver Disease

Management of Multidrug-Resistant Infections in Cirrhosis

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