Management of bacterial and fungal infections in cirrhosis: The MDRO challenge - PubMed (original) (raw)
Review
. 2021 Jul:75 Suppl 1:S101-S117.
doi: 10.1016/j.jhep.2020.11.010.
Affiliations
- PMID: 34039482
- DOI: 10.1016/j.jhep.2020.11.010
Review
Management of bacterial and fungal infections in cirrhosis: The MDRO challenge
Javier Fernández et al. J Hepatol. 2021 Jul.
Abstract
Bacterial infections are frequent in cirrhotic patients with acute decompensation or acute-on-chronic liver failure and can complicate the clinical course. Delayed diagnosis and inappropriate empirical treatments are associated with poor prognosis and increased mortality. Fungal infections are much less frequent, usually nosocomial and associated with extremely high short-term mortality. Early diagnosis and adequate empirical treatment of infections is therefore key in the management of these patients. In recent decades, antibiotic resistance has become a major worldwide problem in patients with cirrhosis, warranting a more complex approach to antibiotic treatment that includes the use of broad-spectrum antibiotics, new administration strategies, novel drugs and de-escalation policies. Herein, we review epidemiological changes, the main types of multidrug-resistant organisms, mechanisms of resistance, new rapid diagnostic tools and currently available therapeutic options for bacterial and fungal infections in cirrhosis.
Keywords: Antibiotic resistance; Antibiotic strategies; Epidemiology; Prevalence; Prognosis.
Copyright © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Conflict of interest statement
Conflict of interest Javier Fernandez has received grant and research support from Grifols and speaker honorarium from MSD and Grifols. Javier Fernandez and Salvatore Piano advise Mallinckrodt. Michele Bartoletti and Emmanuel Q. Wey have nothing to disclose. Please refer to the accompanying ICMJE disclosure forms for further details.
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