Infections complicating cirrhosis

Piano, Salvatore; Brocca, Alessandra; Mareso, Sara; Angeli, Paolo

doi:10.1111/liv.13645

Cited by 145 publications

(148 citation statements)

References 53 publications

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“…In addition, about 20% of patients with infection may acquire second infections during the hospitalization . Risk factors for the development of infections are poor liver function, ascites, low protein concentration in ascitic fluid, GI bleeding, and previous infections . About two‐thirds of these infections are diagnosed at admission (within 48 hours), whereas one‐third are nosocomial.…”

Section: Prevalence Type and Clinical Characteristics Of Infectionsmentioning

confidence: 99%

“…Patients with cirrhosis have a high risk for development of infections and sepsis, which is almost doubled when compared with patients hospitalized for other diseases . The high risk for infections in patients with cirrhosis is due to several factors, namely immune dysfunction, increased intestinal permeability, quantity and quality changes in gut microbiota, and genetic predisposition, contributing to a pathological bacterial translocation from the gut to the systemic circulation …”

mentioning

confidence: 99%

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Current Concepts on Bacterial and Fungal Infections in Cirrhosis

Piano

Angeli

2019

Clinical Liver Disease

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Section: Prevalence Type and Clinical Characteristics Of Infectionsmentioning

confidence: 99%

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confidence: 99%

Current Concepts on Bacterial and Fungal Infections in Cirrhosis

Piano

Angeli

2019

Clinical Liver Disease

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“…(35,37,38) The gut milieu of this population is also adversely affected by multiple antibiotic courses that are often prescribed. (39) Our human trial demonstrated short-term and longterm improvement in cognitive function after antibiotics and FMT, which was not seen in the group that received only standard of care. (9,40) Therefore, our translational results of the pre-FMT and post-FMT stool and supernatant analysis on brain inflammatory expression in GF mice is a highly relevant approach to explore mechanisms and eliminate clinical variables.…”

Section: Discussionmentioning

confidence: 65%

“…However, a substantial proportion of patients with HE recur and have evidence of persistent cognitive impairment despite this standard of care . The gut milieu of this population is also adversely affected by multiple antibiotic courses that are often prescribed . Our human trial demonstrated short‐term and long‐term improvement in cognitive function after antibiotics and FMT, which was not seen in the group that received only standard of care .…”

Section: Discussionmentioning

confidence: 70%

Neuroinflammation in Murine Cirrhosis Is Dependent on the Gut Microbiome and Is Attenuated by Fecal Transplant

et al. 2019

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Cirrhosis and hepatic encephalopathy (HE) is associated with an altered gut–liver–brain axis. Fecal microbial transplant (FMT) after antibiotics improves outcomes in HE, but the impact on brain function is unclear. The aim of this study is to determine the effect of colonization using human donors in germ‐free (GF) mice on the gut–liver–brain axis. GF and conventional mice were made cirrhotic using carbon tetrachloride and compared with controls in GF and conventional state. Additional GF mice were colonized with stool from controls (Ctrl‐Hum) and patients with cirrhosis (Cirr‐Hum). Stools from patients with HE cirrhosis after antibiotics were pooled (pre‐FMT). Stools from the same patients 15 days after FMT from a healthy donor were also pooled (post‐FMT). Sterile supernatants were created from pre‐FMT and post‐FMT samples. GF mice were colonized using stools/sterile supernatants. For all mice, frontal cortex, liver, and small/large intestines were collected. Cortical inflammation, synaptic plasticity and gamma‐aminobutyric acid (GABA) signaling, and liver inflammation and intestinal 16s ribosomal RNA microbiota sequencing were performed. Conventional cirrhotic mice had higher degrees of neuroinflammation, microglial/glial activation, GABA signaling, and intestinal dysbiosis compared with other groups. Cirr‐Hum mice had greater neuroinflammation, microglial/glial activation, and GABA signaling and lower synaptic plasticity compared with Ctrl‐Hum mice. This was associated with greater dysbiosis but no change in liver histology. Pre‐FMT material colonization was associated with neuroinflammation and microglial activation and dysbiosis, which was reduced significantly with post‐FMT samples. Sterile pre‐FMT and post‐FMT supernatants did not affect brain parameters. Liver inflammation was unaffected. Conclusion: Fecal microbial colonization from patients with cirrhosis results in higher degrees of neuroinflammation and activation of GABAergic and neuronal activation in mice regardless of cirrhosis compared with those from healthy humans. Reduction in neuroinflammation by using samples from post‐FMT patients to colonize GF mice shows a direct effect of fecal microbiota independent of active liver inflammation or injury.

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“…Bacterial infections are common in cirrhosis, estimated to occur in 25% to 46% of patients hospitalized with acute decompensation of cirrhosis . The presence of infection triggers a surge of inflammatory response, superimposed on the chronic systemic inflammation related to intestinal dysbiosis, loss of intestinal mucosal integrity, and increased bacterial translocation that is usually present in these patients .…”

mentioning

confidence: 99%