Bacterial infections in cirrhosis

Abstract

Patients with cirrhosis are highly susceptible for bacterial infections and their severe courses. Infections occur more often in advanced stage of liver disease, impair hepatic function, trigger the onset of complications, and are significant factors of mortality as well. Gastrointestinal hemorrhage confers a higher risk for infections and infections play important role in provoking of variceal bleeding episodes and can also be associated with the failure to control bleeding. In the past, the dominant pathogens were Gram-negative bacteria, but nowadays participation of Gram-positive strains has been increasing. Occurrence of opportunistic bacteria is far from rare. Spreading of resistant organisms and appearance of Clostridium difficile associated disease related with higher mortality are increasing problem due to the consequence of repeated antibiotic treatment of recurring infections, multiple hospitalizations and use of long-term antibiotic prophylaxis. In cirrhosis, immunodeficiency is multifactorial and progresses with the disease severity. Thus bacteria commonly get into the circulation from the infection ports causing frequent and prolonged bacteremia. Circulating bacteria colonize and proliferate in different organs inducing secondary focal infections. Intestinal tract considered a significant portal of entry. Translocation of the gut microflora mainly related to the development of spontaneous bacterial peritonitis. It is reasonable to assume that spontaneous bacteremia leads to other systemic infections but this is yet to be outlined adequately. Identification of infectious episodes are challenging due to the lack of typical signs and courses up to fifty percent of the cases. Early recognition and effective treatment of infections are essential in decreasing the high mortality.

Investigation into bacteremia and spontaneous bacterial peritonitis in patients with liver cirrhosis in Japan

“…It has been reported that susceptibility to bacteremia is correlated with severity of liver cirrhosis (17,18). We previously investigated Aeromonas bacteremia in patients with liver cirrhosis, and found that all patients with Aeromonas bacteremia had severe liver cirrhosis with a Child-Pugh score of 13 or greater (19).…”

Assessment of the Fecal Lactobacilli Population in Patients with Hepatitis B Virus-Related Decompensated Cirrhosis and Hepatitis B Cirrhosis Treated with Liver Transplant

“…Liver cirrhosis, a malignant liver disease which is followed by liver failure resulting in high mortality, is also frequently associated with gastrointestinal (GI) complications such as GI bleeding and malnutrition [3,34,43]. Our previous studies showed that increased diversity of virulence factors and instability of the gut microecosystem are related to the severity of liver injury [27].…”

Bacterial infections in patients with liver cirrhosis

“…According to the literature the most common types of bacterial infections in patients with liver cirrhosis are SBP, urinary tract infections and pneumonia, followed by infections of the skin and soft tissue infections, bacteremia and other infections [8,9]. The distribution of types of bacterial infections in our study is consistent with the literature data since it has been found that the most commonly occurring infections are urinary tract infection (21.56%), pneumonia (20.91%), and SBP (18.94%).…”

“…Together, they make up about two thirds of these infections while the remainder belong to infections of the skin and soft tissue infections, bacteremia and other infections [8,9]. Together, they make up about two thirds of these infections while the remainder belong to infections of the skin and soft tissue infections, bacteremia and other infections [8,9].…”