Early Diagnosis and Prevention of Infections in Cirrhosis

Abstract

Cirrhosis is a risk factor for infections. Majority of hospital admissions in patients with cirrhosis are due to infections. Sepsis is an immunological response to an infectious process that leads to end-organ dysfunction and death. Preventing infections may avoid the downstream complications and early diagnosis of infections may improve the outcomes. In this review, we discuss the pathogenesis, diagnosis, and biomarkers of infection, as well as incremental preventive strategies for infections and sepsis and consequent organ failures in cirrhosis. Strategies for primary prevention include reducing gut translocation by selective intestinal decontamination, avoiding unnecessary proton pump inhibitors’ use, appropriate use of beta-blockers and vaccinations for viral diseases, including coronavirus disease-2019. Secondary prevention includes early diagnosis and timely and judicious use of antibiotics to prevent organ dysfunction. Organ failure support constitutes tertiary intervention in cirrhosis. In conclusion, infections in cirrhosis are potentially preventable with appropriate care strategies to then enable to improve outcomes.

Poor immune response to coronavirus disease vaccines in decompensated cirrhosis patients and liver transplant recipients

“…Influenza and SARS-CoV-2 virus-related pneumonia are associated with high morbidity and mortality in patients with cirrhosis. [2] , [16] , [17] , [18] Although vaccination does not prevent infection, all vaccines reduce the need for hospitalization, modify the course of the disease, and improve the short-term and long-term outcomes of viral pneumonia. [6] , [8] , [19] , [20] Therefore, patients with cirrhosis should be vaccinated as a priority group to prevent and modify the course of vaccine-modifiable diseases, including COVID-19.…”

“… [6] , [8] , [19] , [20] Therefore, patients with cirrhosis should be vaccinated as a priority group to prevent and modify the course of vaccine-modifiable diseases, including COVID-19. [16] , [21] …”

Conventional Antibiotics for Spontaneous Bacterial Peritonitis: Are They Still Effective?

“…Optimal antibiotic therapy is key to the successful treatment of SBP. It is well known that using inappropriate antibiotics as first-line therapy is associated with high mortality (1). The choice of initial empiric antibiotic should be guided by local AMR patterns for the clinicians to make an informed decision for better outcomes.…”

“…Patients with cirrhosis are predisposed to infections (1,2). Spontaneous bacterial peritonitis (SBP) is a commonly encountered infection in patients with cirrhosis, with a pooled global prevalence of 17% (3).…”

“…Therefore, the role of prophylactic antibiotic therapy to prevent SBP remains contentious, given the recent reports suggesting an increased risk of drug resistance, higher culture-positivity, and mortality with primary prophylaxis (20,21). In our opinion, nonantibiotic measures, including vaccination for vaccinepreventable diseases, beta-blockers, statins, immunonutrition, albumin infusions, and avoiding proton pump inhibitors to prevent infections, are the way forward, apart from the universal precautions of infection prevention (1).…”