Primary and secondary prophylaxis of spontaneous bacterial peritonitis: current state of the art

Facciorusso, Antonio; Antonino, Matteo; Orsitto, E; Sacco, Rodolfo

doi:10.1080/17474124.2019.1644167

Cited by 18 publications

(14 citation statements)

References 92 publications

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“…SBP is defined by an ascitic neutrophil count of ≥250 cells/mm 3 with a positive ascitic fluid bacterial culture without the evidence of an intra-abdominal, surgically treatable source of infection [ 10 ]. Bacterial cultures on ascitic fluid yield low sensitivity, so the presence of a neutrophil count ≥250 cells/mm 3 with a negative culture result, usually defined as neutrocytic ascites, is a common finding, showing a mortality rate similar to culture-positive SBP and thus requiring equally prompt management.…”

Section: Bacterial Infections In Cirrhotic Patientsmentioning

confidence: 99%

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Prevalence and Therapeutic Management of Infections by Multi-Drug-Resistant Organisms (MDROs) in Patients with Liver Cirrhosis: A Narrative Review

et al. 2022

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Bacterial infections are common events that significantly impact the clinical course of patients with cirrhosis. As in the general population, infections caused by multi-drug-resistant organisms (MDROs) are progressively increasing in cirrhotic patients, accounting for up to 30–35% of all infections. Nosocomial acquisition and prior exposure to antimicrobial treatment or invasive procedures are well-known risk factors for MDRO infections. Several studies have demonstrated that infections due to MDROs have a poorer prognosis and higher rates of treatment failure, septic shock, and hospital mortality. Due to the increasing rate of antimicrobial resistance, the approach to empirical treatment in cirrhotic patients with life-threatening infections has become significantly more challenging. In order to ensure a prompt administration of effective antibiotic therapy while avoiding unnecessary antibiotic exposure at the same time, it is of utmost importance to choose the correct antimicrobial therapy and administration schedule based on individual clinical characteristics and risk factors and rapidly adopt de-escalation strategies as soon as microbiological data are available. In the present paper, we aimed to provide an overview of the most frequent infections diagnosed in cirrhotic patients, the prevalence and impact of antimicrobial resistance, and potential therapeutic options in this population.

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Section: Bacterial Infections In Cirrhotic Patientsmentioning

confidence: 99%

“…Historically, Gram-negative bacteria, especially E. coli , Proteus, and K. pneumoniae , have been considered the leading cause of SBP; however, in recent years, a progressive increase in the prevalence of Gram-positive strains, such as Enterococcus spp. and Staphylococcus aureus , have been observed [ 10 ].…”

Section: Bacterial Infections In Cirrhotic Patientsmentioning

confidence: 99%

Prevalence and Therapeutic Management of Infections by Multi-Drug-Resistant Organisms (MDROs) in Patients with Liver Cirrhosis: A Narrative Review

et al. 2022

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“…Given the pathophysiological concept of the impact of SI on kidney dysfunction in ACLD and the close association between AKI and SBP 108 , antibiotic prophylaxis may display beneficial effects on HRS. Consequently, an RCT by Fernández et al .…”

Section: Managementmentioning

confidence: 99%

Recent advances in the understanding and management of hepatorenal syndrome

Simbrunner

Trauner

Reiberger

et al. 2021

Fac Rev

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Renal dysfunction occurs frequently in hospitalized patients with advanced chronic liver disease (ACLD)/cirrhosis and has profound prognostic implications. In ACLD patients with ascites, hepatorenal syndrome (HRS) may result from circulatory dysfunction that leads to reduced kidney perfusion and glomerular filtration rate (in the absence of structural kidney damage). The traditional subclassification of HRS has recently been replaced by acute kidney injury (AKI) type of HRS (HRS-AKI) and non-AKI type of HRS (HRS-NAKI), replacing the terms “HRS type 1” and “HRS type 2”, respectively. Importantly, the concept of absolute serum creatinine (sCr) cutoffs for diagnosing HRS was partly abandoned and short term sCr dynamics now may suffice for AKI diagnosis, which facilitates early treatment initiation that may prevent the progression to HRS-AKI or increase the chances of AKI/HRS-AKI reversal. Recent randomized controlled trials have established (a) the efficacy of (long-term) albumin in the prevention of complications of ascites (including HRS-AKI), (b) the benefits of transjugular intrahepatic portosystemic shunt placement in patients with recurrent ascites, and (c) the superiority of terlipressin over noradrenaline for the treatment of HRS-AKI in the context of acute-on-chronic liver failure. This review article aims to summarize recent advances in the understanding and management of HRS.

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“…In end-stage liver disease, both albumin concentration and functionality are significantly impaired 30. Therefore, patients with advanced cirrhosis and ascites might benefit from albumin infusions either in terms of the improved immune system with a consequent lower risk of experiencing severe complications such as spontaneous bacterial peritonitis (SBP) and renal perfusion 31,32…”

Section: Management Of Hrsmentioning

confidence: 99%

<p>Hepatorenal Syndrome Type 1: Current Challenges And Future Prospects</p>

Facciorusso¹

2019

TCRM

Self Cite

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Renal dysfunction represents a dreadful complication of advanced liver cirrhosis. In addition to the traditional types of acute kidney injury (AKI) that can occur in the general population, cirrhotics might experience a different kind of renal dysfunction, called hepatorenal syndrome (HRS). The exact definition of HRS is a functional renal dysfunction caused by overactivity of the endogenous vasoactive systems (in particular intrarenal circulation) which lead to reduced renal perfusion. Type I HRS (HRS-1) is characterized by an abrupt deterioration in renal function (in less than 2 weeks), defined by a doubling of baseline sCr to >2.5 mg/dL or a 50% reduction in the initial 24 hrs creatinine clearance to <20 mL/min. Frequent precipitating events leading to HRS-1 are bacterial infections, gastrointestinal hemorrhage, or large-volume paracentesis without adequate albumin administration as well as massive diuretic use. In 2015, the international club of ascites (ICA) revised the definitions and recommendations concerning HRS. The revised definition allows to adopt effective pharmacological therapy based on albumin and vasoconstrictors in an earlier stage thus not influenced anymore by a rigid sCr cut-off value as by the previous definition of HRS-1. The aim of this article was to provide an updated overview of the latest advancements in the field of hepatorenal syndrome and of the recent amendments of the previous definitions of kidney injury in cirrhotic patients.

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Primary and secondary prophylaxis of spontaneous bacterial peritonitis: current state of the art

Cited by 18 publications

References 92 publications

Prevalence and Therapeutic Management of Infections by Multi-Drug-Resistant Organisms (MDROs) in Patients with Liver Cirrhosis: A Narrative Review

Prevalence and Therapeutic Management of Infections by Multi-Drug-Resistant Organisms (MDROs) in Patients with Liver Cirrhosis: A Narrative Review

Recent advances in the understanding and management of hepatorenal syndrome

<p>Hepatorenal Syndrome Type 1: Current Challenges And Future Prospects</p>

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