Bacterial infections in cirrhosis: treatment and prophylaxis

García–Tsao, Guadalupe

doi:10.1016/j.jhep.2004.12.006

Cited by 105 publications

(66 citation statements)

References 73 publications

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“…Moreover, infection has been related to variceal bleeding both in terms of pathogenesis of portal pressure increment and severity of bleeding episodes [24,25] , since the related mortality was reduced by prompt antibiotic therapy [26] . SBP is one of the most frequent infections in patients with cirrhosis [6] . Fever, leukocytosis, and abdominal symptoms are rare (recorded in 20% only of our series); the identification of the infection of ascitic fluid is, therefore, based only on the result of the diagnostic paracentesis.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice

Angeloni

Leboffe²,

Parente³

et al. 2008

WJG

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Aim: To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice. Methods: All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study. SBP was diagnosed when the ascitic fluid polymorphonuclear (PMN) cell count was > 250 cell/mm3, and empirically treated with cefotaxime. Results: Thirty-eight SBP episodes occurred in 32 cirrhotics (22 men/10 women; mean age: 58.6 ± 11.2 years). Prevalence of SBP, in our population, was 17%. Ascitic fluid culture was positive in nine (24%) cases only. Eleven episodes were nosocomial and 71% community-acquired. Treatment with cefotaxime was successful in 59% of cases, while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h. Change of antibiotic therapy led to the resolution of infection in 87% of episodes. Among the cases with positive culture, the initial antibiotic therapy with cefotaxime failed at a percentage (44%) similar to that of the whole series. In these cases, the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime. Conclusion: In clinical practice, ascitic PMN count is a valid tool for starting a prompt antibiotic treatment and evaluating its efficacy. The initial treatment with cefotaxime failed more frequently than expected. An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding. A different first-line antibiotic treatment should be investigated. © 2008 WJG. All rights reserved

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Section: Discussionmentioning

confidence: 99%

“…The prevalence of SBP in unselected, hospitalized, cirrhotic patients with ascites has been reported to range between 10% and 30% [1,[2][3][4][5][6] . Following the first episode of SBP, the cumulative recurrence rate within one year of follow up is approximately 70% [7] .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice

Angeloni

Leboffe²,

Parente³

et al. 2008

WJG

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“…This could happen through the recognition and eradication of primary infections and reduction of intestinal bacterial translocation (-closure of infection ports‖). The most common bacterial infections are SBP (25%), urinary tract infections (UTI) (20%), pneumonia (15%), and bacteremia (12%) [8].…”

Section: Compromised Host Defense Prolonged Bacteremiamentioning

confidence: 99%

“…In cirrhosis, pneumonia is the third most frequent infection (15%). However, the mortality rate of pneumonia is much higher than in any non-cirrhotic population [8]. The defect in early bactericidal activity of alveolar lining components (reduced levels of lysosim and complement C3) explains the extreme sensibility for Pneumococcus pneumonia and the high mortality [52].…”

Section: Airways Infectionsmentioning

confidence: 99%

“…The duration of treatment should be 10 days at least; antibiotics can be omitted after concomitant resolution of clinical symptoms and normalization of CRP level [53]. Newer generation -respiratory fluoroquinolones‖ (levofloxacin, moxifloxacin) having antibacterial activity against GPC as well, can be effectively used in monotherapy for either community-acquired typical or atypical pneumonias [8]. They are also suitable for early oral administration, which increases the cost effectivity of the treatment.…”

Section: Airways Infectionsmentioning

confidence: 99%

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Bacterial infections in cirrhosis

et al. 2007

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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.

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