Novel prevention strategies for bacterial infections in cirrhosis

Abstract

Introduction Bacterial infections are a serious complication of cirrhosis, as they can lead to decompensation, multiple organ failure, and/or death. Preventing infections is therefore very relevant. Because gut bacterial translocation is their main pathogenic mechanism, prevention of infections is mostly based on the use of orally administered poorly absorbed antibiotics such as norfloxacin (selective intestinal decontamination). However, antibiotic prophylaxis leads to antibiotic resistance, limiting therapy and increasing morbidity and mortality. Prevention of bacterial infections in cirrhosis should therefore move away from antibiotics. Areas Covered This review focuses on various potentially novel methods to prevent infections in cirrhosis focusing on non-antibiotic strategies. The use of probiotics, nonselective intestinal decontamination with rifaximin, prokinetics and beta-blockers or fecal microbiota transplant as means of targeting altered gut microbiota, bile acids and FXR agonists are all potential alternatives to selective intestinal decontamination. Prokinetics and beta-blockers can improve intestinal motility, while bile acids and FXR agonists help by improving the intestinal barrier. Finally, granulocyte colony stimulating factor (G-CSF) and statins are emerging therapeutic strategies that may improve immune dysfunction in cirrhosis. Expert Opinion Evidence for these strategies has been restricted to animal studies and proof-of concept studies but we expect this to change in coming years.

Lymphocyte-To-Monocyte Ratio as the Best Simple Predictor of Bacterial Infection in Patients with Liver Cirrhosis

“…Bacterial translocation also causes a proinflammatory state that worsens the hemodynamic status of patients with cirrhosis and leads to decompensation. Immune activation ("cytokine storm") causes the development of cirrhosis-associated immune dysfunction that increases susceptibility to other infections [30][31][32].…”

The impact of carbapenem resistance on clinical deterioration and mortality in patients with liver disease

“…Taking all these considerations into account, it seems that we are gradually entering the post‐antibiotic era . This in particular might be a serious health threat to cirrhotic patients, since antibiotic treatment options are often already restricted . Long‐term prospective data are needed in order to develop preventive strategies to reduce CRGN burden in patients with liver disease.…”

Bacterial Infections in Acute-on-Chronic Liver Failure

“…3). 82 Generally, the novel preventative strategies are as follows. (1) Improving intestinal flora: probiotics, prebiotics, and synbiotics and fecal microbiota transplant (FMT).…”