Infections complicating severe alcoholic hepatitis:<i>Enterococcus</i>species represent the most frequently identified pathogen

Beisel, Claudia; Blessin, Usha B; Wiesch, Julian Schulze zur; Wehmeyer, Malte H.; Lohse, Ansgar W.; Benten, Daniel; Kluwe, Johannes

doi:10.3109/00365521.2016.1157887

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…11% of patients presented with clinically relevant infection, 10% developed infection after admission but prior to steroid initiation and 32% developed an incident infection during steroid treatment but the timing of infection did not influence survival. In agreement with recently published studies, Escherichia and Enterococcus genii were the commonest bacterial pathogens isolated[12,13]. The commonest site of infection was ascites (31%) and 31% had bacterial septicaemia.…”

Section: Discussionsupporting

confidence: 90%

Infection does not increase long-term mortality in patients with acute severe alcoholic hepatitis treated with corticosteroids

Dhanda¹,

Hunt²,

Saleem³

et al. 2017

WJG

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AIMTo determine whether infection in patients with acute severe alcoholic hepatitis (AAH) treated with corticosteroids is associated with increased mortality.METHODSConsecutive patients with AAH were treated with steroids and recruited to the study. Clinically relevant infections (body temperature > 38 °C or < 36 °C for more than 4 h, ascitic neutrophil count > 0.25 ×109/L, consolidation on chest radiograph or clinically relevant positive microbiological culture of bodily fluid) were recorded prospectively. Clinical and laboratory parameters were recorded and survival at 90 d and 6 mo was determined. Univariate analysis of factors associated with 90-d mortality was performed and significant variables included in a multivariate analysis.RESULTSSeventy-two patients were included in the final analysis (mean age 47.9 years, 26% female, mean discriminant function 53.0). Overall mortality in the group occurred in 15 (21%), 23 (32%) and 31 (43%) at day 28, day 90 and 1 year respectively. 36 (50%) had a clinically relevant infection during their hospitalisation (23 after initiation of steroids). The median time to development of incident infection after commencement of steroids was 10 d. The commonest site of infection was ascites (31%) and bacteraemia (31%) followed by urinary tract (19%) and respiratory tract (8%). Forty-one separate organisms were isolated in 33 patients; the most frequent genus was Escherichia (22%) and Enterococcus (20%). Infection was not associated with 90-d or 1 year mortality but was associated with higher creatinine, model for end-stage liver disease and Lille score. Baseline urea was the only independent predictor of 90-d mortality.CONCLUSIONClinically relevant infections are common in patients with AAH but are not associated with increased 90-d or 1 year mortality.

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Section: Discussionsupporting

confidence: 90%

Infection does not increase long-term mortality in patients with acute severe alcoholic hepatitis treated with corticosteroids

Dhanda¹,

Hunt²,

Saleem³

et al. 2017

WJG

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“…Enhanced isoprenoid biosynthesis via the mevalonate pathway, mainly seen in gram‐positive pathogens, may contribute to the risk of gram‐positive pathogen infection in SAH. In fact, gram‐positive Enterococcus emerged as the most frequent cause of infection in SAH patients …”

Section: Discussionmentioning

confidence: 99%

“…In fact, gram-positive Enterococcus emerged as the most frequent cause of infection in SAH patients. (45) Notably, in patients with SAH there is shift in function of circulating microbiota with enrichment of the anthranilate degradation pathway. This pathway is significant in forming bacterial biofilm, as shown previously.…”

Section: Discussionmentioning

confidence: 99%

The circulating microbiome signature and inferred functional metagenomics in alcoholic hepatitis

et al. 2018

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“…One of the key mechanisms in AH is the inflammation triggered by bacterial lipopolysaccharides in the portal blood flow due to increased intestinal permeability (Louvet & Mathurin, ). Moreover, infections affect the survival of AH patients (Beisel et al, ). Therefore, antibiotic therapy may have an effect on both pathogenetic mechanisms of AH and infectious complications.…”

Section: Introductionmentioning

confidence: 99%

Noncholesterol Sterols as Surrogate Markers in Patients with Severe Alcoholic Hepatitis

Sahlman

Nissinen

Simonen

et al. 2018

Lipids

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Severe alcoholic hepatitis (AH) is a life-threatening condition lacking good serologic markers to tailor treatment and predict recovery. We examined the cholesterol metabolism in severe AH to explore prognostic markers and evaluate the profile of cholesterol precursors, cholestanol and phytosterols, in this context. We assessed serum cholesterol, cholesterol precursors, cholestanol, phytosterols, and biochemical markers in 24 patients with severe AH treated with prednisolone and randomized to ciprofloxacin in the ratio 1:1. Response to prednisolone was assessed with the Lille model. Evaluations were made between responders and nonresponders to corticosteroid treatment and during follow-up for 180 days. The findings were compared with those from patients with primary sclerosing cholangitis (PSC) (n = 156) and healthy individuals (n = 124). Responders to prednisolone had ~56-60% higher (p-value 0.032-0.044) serum ratios to cholesterol of phytosterols, while the lathosterol/campesterol ratio was ~76% (p = 0.031) lower compared to nonresponders. Stigmasterol/cholesterol predicted response to corticosteroid therapy. Surrogate markers of cholesterol synthesis (lathosterol and desmosterol) inversely reflected those of absorption (cholestanol and phytosterols) in PSC and controls (r-range -0.247 to -0.559, p < 0.01 for all), contrary to AH patients, among whom this reciprocal regulation was partially recovered on day 90 (lathosterol: r-range -0.733 to -0.952, p < 0.05 for all). AH patients had ~26% lower lathosterol/cholesterol, but 1.13-3.87-fold higher cholestanol/cholesterol and sitosterol/cholesterol compared to control groups (p < 0.05 for all). Median ferritin concentration at baseline was ~37% lower (p = 0.011) among the responders. Cholesterol precursors and phytosterols have a disease-specific profile in AH. Phytosterols and ferritin may serve as surrogate markers for short-term response.

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Infections complicating severe alcoholic hepatitis:Enterococcusspecies represent the most frequently identified pathogen

Abstract: Infections frequently complicate severe alcoholic hepatitis and affect survival. The high rate of Enterococcus infections suggests that commonly used antibiotics, such as cephalosporins and quinolones, may represent an ineffective choice of empiric antibiotic treatment for complicated AH.

Cited by 5 publications

References 21 publications

Infection does not increase long-term mortality in patients with acute severe alcoholic hepatitis treated with corticosteroids

Infection does not increase long-term mortality in patients with acute severe alcoholic hepatitis treated with corticosteroids

The circulating microbiome signature and inferred functional metagenomics in alcoholic hepatitis

Noncholesterol Sterols as Surrogate Markers in Patients with Severe Alcoholic Hepatitis

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