Spontaneous bacteremia and spontaneous bacterial peritonitis share similar prognosis in patients with cirrhosis: a cohort study

Marciano, Sebastián; Dirchwolf, Melisa; Bermúdez, Carla; Sobenko, Natalia; Haddad, Leila; Bert, F.; Barcán, Laura; Smud, Astrid; Posadas‐Martinez, María Lourdes; Giunta, Diego; Gadano, Adrián

doi:10.1007/s12072-017-9837-7

Cited by 16 publications

(15 citation statements)

References 24 publications

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“…Survival after the first episode is estimated to be 40% at 1 year 14. Acute kidney injury occurs in as much as 54% of the patients, and acute-on-chronic liver failure occurs in 35%–60% of the patients, despite appropriate treatment 15–18. In Table 1, the incidence of death and acute kidney injury in patients with spontaneous bacterial peritonitis is detailed.…”

Section: Clinical Aspects and Bacteriologymentioning

confidence: 99%

Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies

Marciano¹,

Dı́az²,

Dirchwolf³

et al. 2019

HMER

Self Cite

102

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Spontaneous bacterial peritonitis is the most frequent bacterial infection in patients with cirrhosis. The reported incidence varies between 7% and 30% in hospitalized patients with cirrhosis and ascites, representing one of their main complications. Outcomes in patients with spontaneous bacterial peritonitis are poor since acute kidney injury, acute-on-chronic liver failure, and death occur in as much as 54%, 60%, and 40% of the patients, respectively, at midterm. Early antibiotic treatment of spontaneous bacterial peritonitis is crucial. However, the landscape of microbiological resistance is continuously changing, with an increasing spread of multidrug-resistant organisms that make its current management more challenging. Thus, the selection of the empirical antibiotic treatment should be guided by the severity and location where the infection was acquired, the risk factors for multidrug-resistant organisms, and the available information on the local expected bacteriology. The use of albumin as a complementary therapy for selected high-risk patients with spontaneous bacterial peritonitis is recommended in addition to antibiotics. Even though antibiotic prophylaxis has proven to be effective to prevent spontaneous bacterial peritonitis, a careful selection of high-risk candidates is crucial to avoid antibiotic overuse. In this article we review the pathogenesis, risk factors, and prognosis of spontaneous bacterial peritonitis, as well as the current evidence regarding its treatment and prophylaxis.

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Section: Clinical Aspects and Bacteriologymentioning

confidence: 99%

Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies

Marciano¹,

Dı́az²,

Dirchwolf³

et al. 2019

HMER

Self Cite

102

View full text Add to dashboard Cite

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“…An earlier version of this work was presented as an abstract at the 27th Annual Conference of APASL (Asian Pacific Association for the Study of the Liver), March 14–18, 2018, New Delhi, India [ 50 ].…”

Section: Disclosurementioning

confidence: 99%

Distinct Changes of BTLA and HVEM Expressions in Circulating CD4⁺ and CD8⁺ T Cells in Hepatocellular Carcinoma Patients

Liu

He³

et al. 2018

Journal of Immunology Research

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BTLA/HVEM (B and T lymphocyte attenuator/herpes virus entry mediator) pathways play a critical role in T cell suppression in tumor. However, its dynamic changes in different T cell subsets in peripheral blood and their clinical significance are largely unclear in cancer patients. In the current study, we showed distinct changes of BTLA and HVEM expressions on peripheral blood CD4+ and CD8+ T cells in patients with hepatocellular carcinoma (HCC); BTLA expression were significantly upregulated on circulating CD4+ but not CD8+ T cells. In sharp contrast, the levels of HVEM expression were significantly downregulated on circulating CD8+ but not CD4+ T cells. A strong positive correlation between BTLA expression on circulating CD4+ T cells and BTLA expression on autologous CD8+ counterparts was observed in healthy donors but absent in HCC patients. More importantly, we found that blockade of the BTLA/HVEM pathway increased IFN-γ production in both circulating CD4+ and CD8+ T cells. Collectively, our data suggested that the BTLA/HVEM pathway contributes to peripheral T cell suppression in HCC patients, and BTLA/HVEM may serve as attractive targets for HCC immunotherapy.

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“…In the latter study, MDR infections accounted for 18%-23% of all identified bacteria[22]. Several authors have reported similar or even higher rates of MDR bacteria in different geographies and settings (up to one-half of bacterial infections in health-care acquired settings were caused by MDR bacteria)[23,24]. The main risk factors identified for the development of MDR infections were prior contact with the health-care system, a nosocomial or health-associated origin of infection, the use of norfloxacin prophylaxis, recent use of other antibiotics (cephalosporins or beta-lactams) or recent infection by MDR bacteria[22,23,25].…”

Section: Pitfalls Of Antibiotic Prophylaxis In Cirrhosis: Emergence Omentioning

confidence: 99%

Unresolved issues in the prophylaxis of bacterial infections in cirrhosis patients

Dirchwolf

Marciano

Martínez

et al. 2018

WJH

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Bacterial infections are highly prevalent and a frequent cause of hospitalization and short-term mortality in patients with cirrhosis. Due to their negative impact on survival, antibiotic prophylaxis for bacterial infections in high-risk subgroups of patients with cirrhosis has been the standard of care for decades. Patients with prophylaxis indications include those at risk for a first episode of spontaneous bacterial peritonitis (SBP) due to a low ascitic fluid protein count and impaired liver and kidney function, patients with a prior episode of SBP and those with an episode of gastrointestinal bleeding. Only prophylaxis due to gastrointestinal bleeding has a known and short-time duration. All other indications imply long-lasting exposure to antibiotics - once the threshold requirement for initiating prophylaxis is met - without standardized criteria for re-assessing antibiotic interruption. Despite the fact that the benefit of antibiotic prophylaxis in reducing bacterial infections episodes and mortality has been thoroughly reported, the extended use of antibiotics in patients with cirrhosis has also had negative consequences, including the emergence of multi-drug resistant bacteria. Currently, it is not clear whether restricting the use of broad and fixed antibiotic regimens, tailoring the choice of antibiotics to local bacterial epidemiology or selecting non-antibiotic strategies will be the preferred antibiotic prophylaxis strategy for patients with cirrhosis in the future.

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Spontaneous bacteremia and spontaneous bacterial peritonitis share similar prognosis in patients with cirrhosis: a cohort study

Abstract: Short-term acute kidney injury and mortality rates were similar in patients with spontaneous bacteremia and spontaneous bacterial peritonitis. Risk assessment of patients with spontaneous bacteremia can be performed with baseline MELD score.

Cited by 16 publications

References 24 publications

Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies

Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies

Distinct Changes of BTLA and HVEM Expressions in Circulating CD4⁺ and CD8⁺ T Cells in Hepatocellular Carcinoma Patients

Unresolved issues in the prophylaxis of bacterial infections in cirrhosis patients

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Spontaneous bacteremia and spontaneous bacterial peritonitis share similar prognosis in patients with cirrhosis: a cohort study

Abstract: Short-term acute kidney injury and mortality rates were similar in patients with spontaneous bacteremia and spontaneous bacterial peritonitis. Risk assessment of patients with spontaneous bacteremia can be performed with baseline MELD score.

Cited by 16 publications

References 24 publications

Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies

Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies

Distinct Changes of BTLA and HVEM Expressions in Circulating CD4+ and CD8+ T Cells in Hepatocellular Carcinoma Patients

Unresolved issues in the prophylaxis of bacterial infections in cirrhosis patients

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Product

Resources

About

Distinct Changes of BTLA and HVEM Expressions in Circulating CD4⁺ and CD8⁺ T Cells in Hepatocellular Carcinoma Patients