Endotipsitis-persistent infection of transjugular intrahepatic portosystemic shunt: pathogenesis, clinical features and management

Bloodstream infections in patients with liver cirrhosis

“…Despite the first description of the disease dates back to 1998, the absence of a standard case definition for endotipsitis or TIPS-related infection could have contributed to an underestimation of its true incidence, which it is esteemed to affect 1 to 5% of patients. 62,63 Endotipsitis should be considered if sustained bacteremia is present in a patient with TIPS, with or without thrombus or vegetation plus either no other identifiable infective primary focus after an exhaustive diagnostic workup. 62,64,65 Of note, together with S. aureus and coagulase-negative Staphylococci, GNB are commonly isolated in patients with suspected TIPSrelated infection, reflecting the common endogenous route of infection and the epidemiology of BSI of patients with LC.…”

“…62,64,65 Of note, together with S. aureus and coagulase-negative Staphylococci, GNB are commonly isolated in patients with suspected TIPSrelated infection, reflecting the common endogenous route of infection and the epidemiology of BSI of patients with LC. [63][64][65] The mortality rate of endopsitis without liver transplantation, which could represent the only definitive treatment for this kind of infection, is very high, approximately of 24-60% of cases. 63,64 and seems to be higher in case of S.aureus and Candida spp infection.…”

“…[63][64][65] The mortality rate of endopsitis without liver transplantation, which could represent the only definitive treatment for this kind of infection, is very high, approximately of 24-60% of cases. 63,64 and seems to be higher in case of S.aureus and Candida spp infection. 66 Therapeutic management -antimicrobial pharmacokinetics/ pharmacodynamic issues in liver cirrhosis…”

New Case of Endotipsitis: Urgent Need for Clinical Practice Guidelines

“…The pathogenesis implies a damaged pseudoendothelium in the luminal surface of the stent graft, or less frequently the development of a bilio-venous fistula [8]. Early infection (<120 days) has been hypothesized to be the result of bacterial seeding during the initial procedure, and late infection may occur months to years after TIPS insertion, mostly following TIPS revision including balloon dilatation of stent stenosis, as it was in our case [2,6]. 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].…”

“…Following recommendations by Mizrahi M. et al [6], we administered ceftriaxone (2 g/day) intravenously for 6 weeks and due to the recurrence of bacteremia after the 2-and 5-week antibiotic course and the absence of toxic effects, we decided to maintain oral treatment with cefuroxime (500 mg twice daily) through 12 months until September 2016. At 6-month follow-up, the patient remained asymptomatic.…”