Problems of bacterial infection in patients with liver disease.

Wyke, R J

doi:10.1136/gut.28.5.623

Cited by 167 publications

(92 citation statements)

References 128 publications

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“…Although there are very few studies on bacteremia in cirrhosis and in most of them no distinction was made between spontaneous bacteremia and bacteremia associated with invasive procedures, it is interesting to note that between 30% and 50% of organisms isolated in these studies were GPC. 2,19,[37][38][39][40][41] This contrasts with the 20% or less incidence of SBP caused by GPC in most reported series. 2,19,38 In the current study special care was taken to differentiate bacteremia associated with invasive procedures and catheter sepsis from spontaneous bacteremia.…”

Section: Discussioncontrasting

confidence: 44%

Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis

et al. 2002

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The extensive use of invasive procedures and of long-term norfloxacin prophylaxis in the management of cirrhotic patients may have influenced the epidemiology of bacterial infections in cirrhosis. We conducted a prospective evaluation of all bacterial infections diagnosed in patients with cirrhosis in a Liver Unit between April 1998 and April 2000. A total of 405 patients presented 572 bacterial infections in 507 admissions. Spontaneous bacterial peritonitis was the most frequent infection (138 cases). Gram-positive cocci were responsible for 53% of total bacterial infections in the study, being the main bacteria isolated in nosocomial infections (59%). Patients requiring treatment in an intensive care unit and those submitted to invasive procedures presented a higher rate of infections caused by grampositive cocci (77% vs. 48%, P < .001 and 58% vs. 40%, P < .02, respectively). B acterial infection is one of the most important clinical problems in patients with decompensated cirrhosis. It is present at admission or develops during hospitalization in 20% to 60% of the patients. 1-8 On the other hand, it is a common cause of death. Most studies assessing the etiology and clinical types of bacterial infections in cirrhosis were performed in the 1980s. At that time, the most common infections were urinary tract infections, pneumonia, and spontaneous bacterial peritonitis (SBP); most infections were community acquired; and approximately 70% to 80% of the isolated organisms were gram-negative bacilli (GNB). 1-8 However, during the last decade practice in hepatology has considerably changed and this may have influenced the epidemiology of bacterial infections in liver diseases. Treatment of cirrhotic patients with severe complications in intensive care units has been generalized, particularly with the extension of the liver transplantation programs, and the invasive procedures used in this setting are frequently associated with iatrogenic complications including infections. 9 On the other hand, new invasive treatments have been developed and are extensively used for specific complications of cirrhosis, including variceal ligation, transjugular intrahepatic portosystemic shunt, and arterial embolization or percutaneous ablation of hepatocellular carcinoma. These treatments may be also associated with infections. Finally, long-term selective intestinal decontamination with norfloxacin, which was introduced in 1987, is now widely used for the primary and secondary prophylaxis of SBP and spontaneous bacteremia in cirrhosis. 10,11 Norfloxacin prevents infections caused by GNB but not those caused by gram-positive cocci (GPC). All these features may have changed the type and etiology of acute bacterial infections in cirrhosis. However, there is no study on this topic.Another relevant problem, which has not been adequately evaluated is the clinical relevance of infections caused by quinoloneresistant gram-negative bacilli (QR-GNB) in cirrhosis. It is well known that patients submitted to long-term selective intestinal deconta...

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Section: Discussioncontrasting

confidence: 44%

Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis

et al. 2002

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“…1 Gastrointestinal functions such as motility are affected during cirrhosis, and mucosal abnormalities secondary to portal hypertension exist. 39,40 In the current study, although ascites was seen in animals even at 3 months when frank cirrhosis was evident, infection of ascitic fluid was seen only in the 5 th month.…”

Section: Discussionmentioning

confidence: 99%

“…Bacterial infection is responsible for up to one quarter of the deaths of patients with chronic liver disease. 1 Spontaneous bacterial peritonitis (SBP) is a common and serious infection developing in patients with cirrhosis, which is thought to appear as a consequence of impaired defense mechanisms against infection. 2 Clinical and experimental evidence indicate that translocation of bacteria from the intestinal lumen to the bloodstream is directly involved in the pathogenesis of SBP.…”

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confidence: 99%

Intestinal mucosal alterations in rats with carbon tetrachloride-induced cirrhosis: Changes in glycosylation and luminal bacteria

et al. 2006

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Spontaneous bacterial peritonitis is a major cause of mortality after liver cirrhosis. Altered permeability of the mucosa and deficiencies in host immune defenses through bacterial translocation from the intestine due to intestinal bacterial overgrowth have been implicated in the development of this complication. Molecular mechanisms underlying the process are not well known. In order to understand mechanisms involved in translocation of bacteria, this study explored the role of oxidative stress in mediating changes in intestinal mucosal glycosylation and luminal bacterial content during cirrhosis. CCl 4 -induced cirrhosis in rats led to prolonged oxidative stress in the intestine, accompanied by increased sugar content of both intestinal brush border and surfactant layers. This was accompanied by changes in bacterial flora in the gut, which showed increased hydrophobicity and adherence to the mucosa. Inhibition of xanthine oxidase using sodium tungstate or antioxidant supplementation using vitamin E reversed the oxidative stress, changes in brush border membrane sugar content, and bacterial adherence. In conclusion, oxidative stress in the intestine during cirrhosis alters mucosal glycosylation, accompanied by an increased hydrophobicity of luminal bacteria, enabling increased bacterial adherence onto epithelial cells. This might facilitate translocation across the mucosa, resulting in complications such as spontaneous bacterial peritonitis. (HEPATOLOGY 2006;43:837-846.)

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“…[8][9][10][11][12][13] In fact, it is considered that up to 25% of deaths in cirrhotic patients are related to bacterial infection. 7,14 The most frequent causative agents isolated in bacterial infections of cirrhotic patients are gram-negative bacteria of intestinal origin, mainly Escherichia coli. [1][2][3][4][5][6][7][8][11][12][13][14] It has been suggested that the gut may be the source of the infections in these patients, 7,11,12 and the passage of viable bacteria from the gastrointestinal tract to extraintestinal sites (i.e., bacterial translocation) seems to be an important step in the pathogenesis of SBP and other bacterial infections in cirrhotic patients.…”

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confidence: 99%

Infections caused byescherichia coliresistant to norfloxacin in hospitalized cirrhotic patients

Ortiz¹,

Vila²,

Soriano³

et al. 1999

Hepatology

112

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Selective intestinal decontamination with norfloxacin is useful to prevent bacterial infections in several groups of cirrhotic patients at high risk of infection. However, the emergence of infections caused by Escherichia coli resistant to quinolones has recently been observed in cirrhotic patients undergoing prophylactic norfloxacin. Our aim is to determine the characteristics of the infections caused by E. coli resistant to norfloxacin in hospitalized cirrhotic patients. One hundred and six infections caused by E. coli in 99 hospitalized cirrhotic patients were analyzed and distributed into two groups: group I (n ‫؍‬ 67), infections caused by E. coli sensitive to norfloxacin, and group II (n ‫؍‬ 39), infections caused by E. coli resistant to norfloxacin. The clinical and analytical characteristics at diagnosis of the infection were similar in both groups. Previous prophylaxis with norfloxacin was more frequent in group II (15/67, 22.4% vs. 32/39, 82%, P F .0001), as a result of a higher number of patients submitted to continuous long-term prophylaxis in this group, whereas previous short-term prophylaxis was similar in both groups. Infections were more frequently nosocomial-acquired in group II than in group I (17/67, 25.3% vs. 20/39, 51.2%, P ‫؍‬ .01). The type of infections was similar in both groups: urinary tract infections 38 in group I and 24 in group II, spontaneous bacterial peritonitis 8 and 2, spontaneous bacteremia 4 and 4, and bacterascites 1 and 0, respectively (pNS). Mortality during hospitalization was similar in the two groups (4/67, 5.9% vs. 5/39, 12.8%, pNS). None of the E. coli resistant to norfloxacin were also resistant to cefotaxime and only one of them was resistant to amoxicillin-clavulanic acid. Prophylaxis with norfloxacin, usually continuous long-term prophylaxis, favors the development of infections caused by norfloxacin-resistant E. coli. Long-term antibiotic prophylaxis should therefore be restricted to highly selected groups of cirrhotic patients at high-risk of infection. Infections caused by E. coli resistant to norfloxacin show a severity similar to those caused by sensitive E. coli. No significant associated resistance between norfloxacin and the antibiotics most frequently used in the treatment of bacterial infections in cirrhotic patients has been observed.

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Problems of bacterial infection in patients with liver disease.

Cited by 167 publications

References 128 publications

Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis

Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis

Intestinal mucosal alterations in rats with carbon tetrachloride-induced cirrhosis: Changes in glycosylation and luminal bacteria

Infections caused byescherichia coliresistant to norfloxacin in hospitalized cirrhotic patients

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