Management of infections in cirrhotic patients: Report of a Consensus Conference

Abstract

The statements produced by the consensus conference on infection in end-stage liver disease promoted by the Italian Association for the Study of the Liver, are here reported. The topics of epidemiology, risk factors, diagnosis, prophylaxis, and treatment of infections in patient with compensated and decompensated liver cirrhosis were reviewed by a scientific board of experts who proposed 26 statements that were graded according to level of evidence and strength of recommendation, and approved by an independent jury. Each topic was explored focusing on the more relevant clinical questions. By systematic literature search of available evidence, comparison and discussion of expert opinions, pertinent statements answering specific questions were presented and approved. Short comments were added to explain the basis for grading evidence particularly on case of controversial areas.

Nosocomial spontaneous bacterial peritonitis antibiotic treatment in the era of multi-drug resistance pathogens: A systematic review

“…It is well-known how in cirrhotic patients the composition of gut microbiota is altered both from a quantitative and qualitative perspective[6] Moreover, in this context gut’s barrier function and immune response to translocating microbes are hindered[6]. In light of these considerations, it does not come as surprise the historical prevalence of Gram-negative enteric bacteria among the etiological agents of SBP, influencing the empirical therapeutic choice[7]. However, over the last years physicians have been facing an important change in the epidemiology features of SBP, in particular, and of bacterial infections, in broader sense in cirrhotic patients.…”

Low Levels of 25-Hydroxy Vitamin D are Independently Associated with the Risk of Bacterial Infection in Cirrhotic Patients

“…Finally, the proportion of infected patients among the total number of hospitalized patients agreed with that observed in other published cohorts of hospitalized cirrhotic patients. 14 Included patients were mainly middle-aged men (Table 1). Most of them (93%) were white Caucasians.…”

“…Thirdly, the susceptibility to bacterial infection in cirrhotic patients implies other parameters that are not influenced by the vitamin D level, such as episodes of past infection, the frequency of hospitalization, and gastro-intestinal bleeding. 14, 15, 16 Finally, because of the limited period of time of observation, we cannot exclude, although it is unlikely, that some of the patients with a severe deficiency could have had an infection after the period of observation.…”

“…However, focusing mainly of alcoholic cirrhotic patients is of interest, as these patients are more likely to develop a bacterial infection than cirrhotic patients from other causes. 14 The strength of the study lies in testing for 25-OH vitamin D with the same high-quality technique that allowed good inter-patient comparability. All infected patients were diagnosed with strict diagnostic criteria of infection, and almost all patients had bacteriological confirmation.…”

Immunotherapy in the Treatment and Prevention of Infection in Acute-on-chronic Liver Failure

“…The use of antimicrobial agents is indicated in prevention and treatment of infection in selected patient groups -despite predisposition of infection in ACLF, the general use of prophylactic antibiotic treatment is not recommended because of the emerging antimicrobial resistance [16,103]. Antibiotic agents treat the consequence rather than the cause of infectious complications in ACLF and further modify the gut microbiota.…”