Bacterial infections in cirrhosis: Current treatment

Miranda-Zazueta, Godolfino; León-Garduño, Luis A. Ponce de; Aguirre-Valadez, Jonathan; Torre-Delgadillo, Aldo

doi:10.1016/j.aohep.2019.09.011

Cited by 16 publications

(24 citation statements)

References 47 publications

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“…MDROs were more commonly isolated in intensive care units (ICUs) (23.8% vs. 12.2%; p = 0.005) and caused more frequently severe sepsis/shock (30.3% vs. 12.2%, p < 0.001) or acute-on-chronic liver failure (20.5% vs. 9.4%, p < 0.001) in a subsequent study conducted by the same authors [ 6 ]. The poor outcome related to infections due to MDROs among cirrhotic patients was confirmed in other studies [ 7 , 19 ].…”

Section: Multi-drug-resistant Organisms (Mdros): Mechanisms Of Resist...supporting

confidence: 66%

“…Infections caused by MDROs are progressively increasing in patients with liver cirrhosis [12,18,19] [7]. A different geographical distribution of MDR bacterial infections has been described, with a peak rate of 50% in Asia, especially in India (73% of isolates), compared with lower frequencies in North America (16% in the US and 24% in Canada).…”

Section: Multi-drug-resistant Organisms (Mdros): Mechanisms Of Resist...mentioning

confidence: 99%

“…Infections caused by MDROs are progressively increasing in patients with liver cirrhosis [ 12 , 18 , 19 ]. Fernandez et al described a rising prevalence over time of infections due to MDROs among patients with cirrhosis in Spain, with a rate of infections caused by MDR bacteria increasing from 18% in 2005–2007 to 23% in 2010–2011 [ 20 ].…”

Section: Multi-drug-resistant Organisms (Mdros): Mechanisms Of Resist...mentioning

confidence: 99%

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Prevalence and Therapeutic Management of Infections by Multi-Drug-Resistant Organisms (MDROs) in Patients with Liver Cirrhosis: A Narrative Review

et al. 2022

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Bacterial infections are common events that significantly impact the clinical course of patients with cirrhosis. As in the general population, infections caused by multi-drug-resistant organisms (MDROs) are progressively increasing in cirrhotic patients, accounting for up to 30–35% of all infections. Nosocomial acquisition and prior exposure to antimicrobial treatment or invasive procedures are well-known risk factors for MDRO infections. Several studies have demonstrated that infections due to MDROs have a poorer prognosis and higher rates of treatment failure, septic shock, and hospital mortality. Due to the increasing rate of antimicrobial resistance, the approach to empirical treatment in cirrhotic patients with life-threatening infections has become significantly more challenging. In order to ensure a prompt administration of effective antibiotic therapy while avoiding unnecessary antibiotic exposure at the same time, it is of utmost importance to choose the correct antimicrobial therapy and administration schedule based on individual clinical characteristics and risk factors and rapidly adopt de-escalation strategies as soon as microbiological data are available. In the present paper, we aimed to provide an overview of the most frequent infections diagnosed in cirrhotic patients, the prevalence and impact of antimicrobial resistance, and potential therapeutic options in this population.

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Section: Multi-drug-resistant Organisms (Mdros): Mechanisms Of Resist...supporting

confidence: 66%

Section: Multi-drug-resistant Organisms (Mdros): Mechanisms Of Resist...mentioning

confidence: 99%

Section: Multi-drug-resistant Organisms (Mdros): Mechanisms Of Resist...mentioning

confidence: 99%

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Prevalence and Therapeutic Management of Infections by Multi-Drug-Resistant Organisms (MDROs) in Patients with Liver Cirrhosis: A Narrative Review

et al. 2022

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“…The development of spontaneous bacterial peritonitis (SBP), defined as the presence of >250 polymorph nuclear (PMN) cells/mm3, positive ascitic fluid bacterial culture, and no evidence of an intraabdominal infection, is one of the most serious complications associated with ascites [3]. Bacterial translocation (BT) across the bowel wall is thought to be the primary mechanism in the development of SBP [4,5]. Cirrhosis affects millions of people worldwide.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Spontaneous Bacteria Peritonitis in Patients with Hypoalbuminemia and Cirrhosis

Siddique¹,

Quddus²,

Iqbal³

et al. 2021

PJMHS

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Background and Aim: Spontaneous bacterial peritonitis (SBP) is one of the most serious complications of ascites, resulting in liver cirrhosis infection, accounting for approximately 25% of all bacterial infections. Within a diagnostic year, the mortality rate for spontaneous bacterial peritonitis ranges from 30% to 90%. The current study attempted to determine the prevalence of spontaneous bacterial peritonitis in patients with hypoalbuminemia and cirrhosis. Materials and Methods: This cross-sectional study was conducted on 112 cirrhosis with hypoalbuminemia patients at Medical Unit A, Hayatabad Medical Complex Peshawar and department of Gastroenterology AK CMH / Sheikh Khalifa bin Zaid Al Nahyan Hospital, Rawalakot Azad Kashmir. The duration of the study was six months from 5th January 2021 to 5th June 2021. All patients of either gender with liver cirrhosis and hypoalbuminemia aged 20 to 60 years were included in the study. Each individual was asked to provide written informed consent. Each patient's creatinine, albumin, and sodium levels were measured in the laboratory using urine and blood sample tests. Each patient's absence or presence of SBP was recorded according to the operational definition. For data analysis, SPSS version 20 was used. Results: Of the total 112 patients, 59 (52.7%) were male and 53 (473%) were female. The overall mean age of the patients was 43.51±4.58 years whereas male and female patients had 47.36±5.62 and 39.66±3.54 years respectively. The number of patients falling in class B and Child Push class C was 50 (44.6%) and 62 (55.4%) respectively. The prevalence of spontaneous bacterial peritonitis was 48 (42.9%). Out of 48 SBP patients, 29 (60.4%) were male and 19 (39.6%) were female. The prevalence of SBP was seen in 13 (27.1%) cases of Class B and 35 (72.9%) of Class C (Child-Pugh Class) respectively. Hypertension and diabetes mellitus as comorbidities were present in 11 (9.8%) and 25 (22.3%) cases respectively. Conclusion: In the current study, the prevalence of SBP was 42.9%. Our study revealed a higher prevalence of spontaneous bacterial peritonitis in cirrhosis patients. Also, a significant association has been found between spontaneous bacterial peritonitis and child Pugh Class C and Class B whereas SBP had no substantial connotation with gender, etiology, and even age but with disease duration. Keywords: Cirrhosis; Spontaneous Bacterial Peritonitis; Hypoalbuminemia

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“…In addition, liver cirrhosis is also a state of immune dysfunction caused by the excessive activation of proinflammatory cytokines [ 40 ]. In patients with liver cirrhosis, the risk of bacterial infection and sepsis increases due to the abnormal gastrointestinal barrier permeability and bacterial translocation; therefore, it is useful to elucidate the immune microenvironment during chronic liver disease to improve prognosis [ 41 ].…”

Section: The Immune Microenvironment In Liver Inflammation and Fibrosismentioning

confidence: 99%

Tumor Immune Microenvironment and Immunosuppressive Therapy in Hepatocellular Carcinoma: A Review

Oura

Morishita

Tani

et al. 2021

IJMS

224

180

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Liver cancer has the fourth highest mortality rate of all cancers worldwide, with hepatocellular carcinoma (HCC) being the most prevalent subtype. Despite great advances in systemic therapy, such as molecular-targeted agents, HCC has one of the worst prognoses due to drug resistance and frequent recurrence and metastasis. Recently, new therapeutic strategies such as cancer immunosuppressive therapy have prolonged patients’ lives, and the combination of an immune checkpoint inhibitor (ICI) and VEGF inhibitor is now positioned as the first-line therapy for advanced HCC. Since the efficacy of ICIs depends on the tumor immune microenvironment, it is necessary to elucidate the immune environment of HCC to select appropriate ICIs. In this review, we summarize the findings on the immune microenvironment and immunosuppressive approaches focused on monoclonal antibodies against cytotoxic T lymphocyte-associated protein 4 and programmed cell death protein 1 for HCC. We also describe ongoing treatment modalities, including adoptive cell transfer-based therapies and future areas of exploration based on recent literature. The results of pre-clinical studies using immunological classification and animal models will contribute to the development of biomarkers that predict the efficacy of immunosuppressive therapy and aid in the selection of appropriate strategies for HCC treatment.

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Bacterial infections in cirrhosis: Current treatment

Cited by 16 publications

References 47 publications

Prevalence and Therapeutic Management of Infections by Multi-Drug-Resistant Organisms (MDROs) in Patients with Liver Cirrhosis: A Narrative Review

Prevalence and Therapeutic Management of Infections by Multi-Drug-Resistant Organisms (MDROs) in Patients with Liver Cirrhosis: A Narrative Review

Prevalence of Spontaneous Bacteria Peritonitis in Patients with Hypoalbuminemia and Cirrhosis

Tumor Immune Microenvironment and Immunosuppressive Therapy in Hepatocellular Carcinoma: A Review

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