Intestinal Permeability in Cirrhotic Patients With and Without Spontaneous Bacterial Peritonitis: Is the Ring Closed?

Scarpellini, Emidio; Valenza, Venanzio; Gabrielli, Maurizio; Lauritano, Ernesto Cristiano; Perotti, Germano; Merra, Giuseppe; Lago, Antonio Dal; Ojetti, Veronica; Ainora, Maria Elena; Santoro, Michele; Ghirlanda, Giovanni; Gasbarrini, Antonio

doi:10.1038/ajg.2009.558

Cited by 103 publications

(108 citation statements)

References 26 publications

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“…34,35 In a study including 80 cirrhotic patients and 24 controls assessed for intestinal permeability, the risk of SPB and BSI were directly related to the grade of intestinal barrier dysfunction measured by the expression of tight junction protein Claudin-2. 36 …”

Section: Pathophysiology Of Bsis In Patients With Liver Cirrhosis: Inmentioning

confidence: 99%

Bloodstream infections in patients with liver cirrhosis

et al. 2016

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Bloodstream infections are a serious complication in patients with liver cirrhosis. Dysregulated intestinal bacterial translocation is the predominant pathophysiological mechanism of infections in this setting. For this reason enteric Gram-negative bacteria are commonly encountered as the first etiological cause of infection. However, through the years, the improvement in the management of cirrhosis, the recourse to invasive procedures and the global spread of multidrug resistant pathogens have importantly changed the current epidemiology. Bloodstream infections in cirrhotic patients are characterized by high mortality rate and complications including metastatic infections, infective endocarditis, and endotipsitis (or transjugular intrahepatic portosystemic shunt-related infection). For this reason early identification of patients at risk for mortality and appropriated therapeutic management is mandatory. Liver cirrhosis can significantly change the pharmacokinetic behavior of antimicrobials. In fact hypoproteinaemia, ascitis and third space expansion and impairment of renal function can be translated in an unpredictable drug exposure.

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Section: Pathophysiology Of Bsis In Patients With Liver Cirrhosis: Inmentioning

confidence: 99%

Bloodstream infections in patients with liver cirrhosis

et al. 2016

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“…It has been suggested that acid-suppressive therapy with proton pump inhibitors (PPIs), which is widely used in patients with cirrhosis, may increase the risk of bacterial infections, since they cause bacterial overgrowth in the small intestine and increase intestinal permeability [87][88][89][90][91][92] . Several studies, including a meta-analysis [93] of four studies involving a total of 772 patients [94][95][96][97][98] , found significant association between PPI and the development of SBP in patients with cirrhosis (odds ratio 2.77, 95%CI: 1.82-4.23).…”

Section: Secondary Prophylaxis In Patients With Prior Sbpmentioning

confidence: 99%

Diagnosis and management of bacterial infections in decompensated cirrhosis

Pleguezuelo

Benítez²,

Jurado³

et al. 2013

WJH

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Bacterial infections are one of the most frequent complications in cirrhosis and result in high mortality rates. Patients with cirrhosis have altered and impaired immunity, which favours bacterial translocation. Episodes of infections are more frequent in patients with decompensated cirrhosis than those with compensated liver disease. The most common and life-threatening infection in cirrhosis is spontaneous bacterial peritonitis followed by urinary tract infections, pneumonia, endocarditis and skin and soft-tissue infections. Patients with decompensated cirrhosis have increased risk of developing sepsis, multiple organ failure and death. Risk factors associated with the development of infections are severe liver failure, variceal bleeding, low ascitic protein level and prior episodes of spontaneous bacterial peritonitis (SBP). The prognosis of these patients is closely related to a prompt and accurate diagnosis. An appropriate treatment decreases the mortality rates. Preventive strategies are the mainstay of the management of these patients. Empirical antibiotics should be started immediately following the diagnosis of SBP and the first-line antibiotic treatment is third-generation cephalosporins. However, the efficacy of currently recommended empirical antibiotic therapy is very low in nosocomial infections including SBP, compared to community-acquired episodes. This may be associated with the emergence of infections caused by Enterococcus faecium and extended-spectrum β-lactamaseproducing Enterobacteriaceae, which are resistant to the first line antimicrobial agents used for treatment. The emergence of resistant bacteria, underlines the need to restrict the use of prophylactic antibiotics to patients with the greatest risk of infections. Nosocomial infections should be treated with wide spectrum antibiotics. Further studies of early diagnosis, prevention and treatment are needed to improve the outcomes in patients with decompensated cirrhosis.

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“…This disturbance allows for overgrowth and translocation of enteric bacteria, typically Gram-negative enteric bacteria (16)(17)(18). Cirrhosis also predisposes an individual to overgrowth of bacterial flora and may lead to increased intestinal permeability (19,20). Deficiencies of local immune response in patients with liver cirrhosis may also contribute to the development of SBP.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance and Characterization of Streptococcus tigurinus Isolates in an Adult Population

Bourassa

Clarridge

2015

J Clin Microbiol

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Streptococcus tigurinus is a newly described member of the Streptococcus mitis group. Due to the difficulty in distinguishing viridans group streptococci (VGS) by phenotype, analysis of 16S rRNA sequences is necessary for the accurate identification of most species. Through a laboratory policy of analyzing all clinically significant isolates from the VGS group by16S rRNA gene sequencing, we identified 14 S. tigurinus isolates from 11 patients. The Vitek 2 system most commonly gave an excellent rating to an incorrect identification (e.g., Streptococcus mitis), as did matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) (e.g., Streptococcus oralis). S. tigurinus strains were recovered from numerous body sites, including the blood, peritoneal fluid, bone, synovial fluid, a perianal abscess, and an arm wound. Retrospective chart review indicated that most isolates were clinically significant, with bacteremia (n ‫؍‬ 5), soft tissue infections (n ‫؍‬ 3) osteomyelitis (n ‫؍‬ 2), infected joint prosthesis (n ‫؍‬ 2), and peritonitis (n ‫؍‬ 2) being the most common, thus expanding the spectrum of disease associated with S. tigurinus. Streptococcus tigurinus was first described after isolation from a patient with infective endocarditis. Isolates of alpha-hemolytic, catalase-negative Gram-positive cocci were recovered from multiple blood cultures of a 74-year-old patient. The isolates were initially identified as viridans group streptococci (VGS). However, analysis of 16S rRNA sequences revealed that the isolates were distinct members of the Streptococcus mitis group (SMG) and were closely related to Streptococcus pneumoniae, Streptococcus pseudopneumoniae, Streptococcus mitis, Streptococcus infantis, and Streptococcus oralis (1). This novel Streptococcus strain was named Streptococcus tigurinus. Since the first report of S. tigurinus infection in 2012, S. tigurinus has been isolated from several additional sterile sites, including cerebrospinal fluid, heart valves, and joint fluid (2, 3). It has been associated with serious invasive infections, including infective endocarditis, culture-negative endocarditis, spondylodiscitis, bacteremia, meningitis, prosthetic joint infections, and thoracic empyema (2, 4). Small colony variants of S. tigurinus were associated with a prosthetic joint infection (3). S. tigurinus has also been isolated from the subgingival plaque of a patient with periodontitis (5). In vitro studies have shown S. tigurinus to be highly virulent in a rat model of experimental endocarditis (6).Because of its relatedness to SMG, S. tigurinus has been hypothesized to be a commensal of the human oral cavity. Data to support this hypothesis, however, are conflicting (7). In a screen of saliva specimens from 31 volunteers, S. tigurinus was not identified among the more than 600 strains of alpha-hemolytic bacterial colonies isolated (2). In a second study that used a specific 16S rRNA gene real-time TaqMan PCR assay, however, S. tigurinus was detected in the saliva and subgingiv...

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Intestinal Permeability in Cirrhotic Patients With and Without Spontaneous Bacterial Peritonitis: Is the Ring Closed?

Cited by 103 publications

References 26 publications

Bloodstream infections in patients with liver cirrhosis

Bloodstream infections in patients with liver cirrhosis

Diagnosis and management of bacterial infections in decompensated cirrhosis

Clinical Significance and Characterization of Streptococcus tigurinus Isolates in an Adult Population

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