A retrospective study of bacterial infections in cirrhosis (original) (raw)
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Bacterial infections in cirrhosis A critical review and
Bacterial infection is common and accounts for major morbidity and mortality in cirrhosis. Patients with cirrhosis are immunocompromised and increased susceptibility to develop spontaneous bacterial infections, hospital-acquired infections, and a variety of infections from uncommon pathogens. Once infection develops, the excessive response of pro-inflammatory cytokines on a pre-existing hemodynamic dysfunction in cirrhosis further predispose the development of serious complications such as shock, acute-on-chronic liver failure, renal failure, and death. Spontaneous bacterial peritonitis and bacteremia are common in patients with advanced cirrhosis, and are important prognostic landmarks in the natural history of cirrhosis. Notably, the incidence of infections from resistant bacteria has increased significantly in healthcare-associated settings. Serum biomarkers such as procalcitonin may help to improve the diagnosis of bacterial infection. Preventive measures (e.g. , avoidance, antibiotic prophylaxis, and vaccination), early recognition, and proper management are required in order to minimize morbidity and mortality of infections in cirrhosis.
Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study
Digestive and Liver Disease, 2001
Aims, To evaluate the prevalence, incidence and clinical relevance of bacterial infection in predominantly non-alcoholic cirrhotic patients hospitalised for decompensation. Patients/Methods. A total of 405 consecutive admissions in 361 patients 1249 males and 112 females; 66 Child-Pugh class 8 and 295 class C] were analysed. Blood, urine, ascitic and pleural fluid cultures were performed within the first 24 hours, during hospitalisation whenever infection was suspected, and again before discharge. Results. Over a one year period, 150 [340/o) bacterial infections [89 community-and 6 I hospital-acquired] involving urinary tract (4 I %], ascites (23%], blood [2 I %] and respiratory tract [I 7%] were diagnosed. The prevalence of bacterial peritonitis was 12%. Infections were asymptomatic in 69 cases [46%] and 130 [87%] involved a single site. Enteric flora accounted for 62% of infections, Escherichia Coli being the most frequent pathogen (25%]. Community-acquired infections were associated with more advanced liver disease [Child-Pugh mean score IO. 2k2.1 versus 9.52 1.9, pcO.O5], renal failure @CO. OS], and high white blood cell count [pcO.Ol].
Infections in patients affected by liver cirrhosis: an update
Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2017
Patients with liver cirrhosis present an increased incidence of infections. The main cause has been founded in alterations of the enteric flora and of the intestinal barrier probably due to portal hypertension, in addition to a reticulo-endothelial system dysfunction. Furthermore, those living with cirrhosis can report a high predisposition to sepsis and septic shock, due to the excessive response of pro-inflammatory cytokines and a complessive hemodynamic derangement. By the analysis in the experimental model of the cirrhotic rat, it was demonstrated that radio-labelled Escherichia coli given by the oral route resulted in the location of the bacteria in the gut, the ascitic fluid and mesenteric lymph nodes, a phenomenon known as bacterial translocation. Bacteria encountered with the highest frequency are those colonizing the intestinal tract, such as E. coli, Klebsiella pneumoniae and Enterobacteriaceae, intracellular bacteria and parasites are reported with a lower frequency. Mult...
The impact of bacterial infections on survival of patients with decompensated cirrhosis
Annals of Hepatology, 2014
Introduction. Bacterial infection in cirrhotic patients is a severe complication that requires early recognition and specific therapeutic care. Material and methods. In this review the various aspects of diagnosis and management of infections that may impact survival in cirrhosis are analyzed. Results. Active search for infections allows early detection and its treatment with suitable antibiotics has reduced mortality rates in spontaneous bacterial peritonitis, the main infection in patients with decompensated cirrhosis. Other common infections, such as bacteremia and septicemia or urinary tract, lung, skin and soft tissue infections must be thoroughly investigated so that antibiotic treatment can be started early. As intestinal bacterial translocation is one of the most important mechanisms for development of bacterial infections, selective intestinal decontamination is able to prevent these infections in populations at risk. After the first episode of spontaneous bacterial peritonitis, poorly absorbed oral antibiotics, such as quinolones, must be started and continued. Moreover, when there is upper gastrointestinal bleeding, infection prevention should be based on oral administration of quinolones or intravenous administration of cephalosporins, both for seven days, to avoid morbidity and early lethality. With the advent of resistance to commonly used antibiotics and recent reports of multiresistant bacteria, there is a need for stricter control when administering antibiotics to cirrhotic patients. Conclusion. Existing knowledge of therapy and prophylaxis for bacterial infections in cirrhotic patients, which undoubtedly improve survival, should be disseminated and applied in clinical practice for the benefit of the population at large.
Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide
Gastroenterology
Background and aims: Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis. Methods: We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America), from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during the hospitalization. Patients were followed until death, liver transplantation, or discharge. Results: The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% CI, 31%-37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were: infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and the site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. The administration of an adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival. Conclusions: In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to reduce the spread of MDR bacteria in patients with cirrhosis.
Revista española de enfermedades digestivas : organo oficial de la Sociedad Española de Patología Digestiva, 2002
Spontaneous bacterial peritonitis is a common and severe complication in patients with cirrhosis and ascitis. Its prognosis clearly depends on its precocious clinical recognition and efficacious therapy. To optimize a treatment protocol, after auditing clinical efficacy and describe microorganisms implicated at our institution. Retrospective study of clinical files of patients with hepatic cirrhosis with positive culture of ascitic fluid (AF) and/or an AF polymorphonuclear (PMN) count of more than 250/mm3, treated at our units between 1st January, 2000 and 31st December, 2001 (n = 38). Patients showed a median age of 49 years (30-76), 63% of which were male. Forty-eight percent were classified as belonging to Child-Pugh B class, and 52% to C. First, considering cases with PMN > 250/mm3 (n = 29), antibiotics were given to all patients (cefotaxime and ampiciline). Fifty-two percent had hepatic encephalopathy, 42% had fever, 66% abdominal pain. In 42% a microorganism was isolated. A...
Tropical Doctor, 2020
Spontaneous bacterial peritonitis (SBP) is an acute bacterial infection of ascitic fluid without an obvious source. The prevalence of SBP in patients with cirrhosis is in the range of 10%–30%. With increasing use of antibiotics, there is a gradual shift in the causative flora of SBP from Gram-negative bacteria to Gram-positive and, more importantly, to drug-resistant bacteria. The aim of this retrospective study on 721 cases was to identify the prevalence of various organisms causing SBP along with their drug sensitivity and resistance patterns. A prevalence of 38.2% culture positivity was observed in our South Indian population. Escherichia coli was the most common pathogen isolated. Third-generation cephalosporins showed high rates of resistance, but a susceptibility of 74.5% to amikacin was found. Nonetheless, 42% of culture-positive isolates exhibited multidrug resistance, the highest rates being seen with Enterococcus faecium (64.2%) and Acinetobacter baumannii (71.4%).
Diagnosis and management of bacterial infections in decompensated cirrhosis
World journal of hepatology, 2013
Bacterial infections are one of the most frequent complications in cirrhosis and result in high mortality rates. Patients with cirrhosis have altered and impaired immunity, which favours bacterial translocation. Episodes of infections are more frequent in patients with decompensated cirrhosis than those with compensated liver disease. The most common and life-threatening infection in cirrhosis is spontaneous bacterial peritonitis followed by urinary tract infections, pneumonia, endocarditis and skin and soft-tissue infections. Patients with decompensated cirrhosis have increased risk of developing sepsis, multiple organ failure and death. Risk factors associated with the development of infections are severe liver failure, variceal bleeding, low ascitic protein level and prior episodes of spontaneous bacterial peritonitis (SBP). The prognosis of these patients is closely related to a prompt and accurate diagnosis. An appropriate treatment decreases the mortality rates. Preventive str...