The intestinal flora and bacterial infection in cirrhosis

Riordan, Stephen M.; Williams, Roger

doi:10.1016/j.jhep.2006.08.001

Cited by 98 publications

(75 citation statements)

References 170 publications

(217 reference statements)

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“…Various studies have confirmed that the bacterial flora is altered and intestinal permeability increased in cirrhosis [18,19]. However, it remains unclear if increased intestinal per-meability to macromolecules demonstrated in these studies, actually infers a barrier defect to bacterial products, including viable organisms.…”

Section: Discussionmentioning

confidence: 84%

Activated intestinal macrophages in patients with cirrhosis release NO and IL-6 that may disrupt intestinal barrier function

Plessis

Vanheel

Janssen

et al. 2013

Journal of Hepatology

153

123

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Background & Aims: Bacterial infections commonly occur in decompensated cirrhosis resulting from bacterial translocation from the intestine. We studied the role of intestinal macrophages and the epithelial barrier in cirrhosis. Methods: Forty-four patients with NASH/ASH cirrhosis (decom-pensated n = 29, compensated n = 15) and nineteen controls undergoing endoscopy were recruited. Serum was obtained and LPS and LBP levels determined. Intestinal macrophages were characterized by flow cytometry, immunohistochemistry, and nitric oxide (NO) production measured in supernatant of cultured duodenal samples. Quantitative RT-PCR was performed on duo-denal biopsies assessing 84 inflammatory genes. Protein levels of cytokines/chemokines were assessed in serum and superna-tant. The duodenal wall was assessed by electron microscopy, tight junction protein expression determined by RT-PCR, immu-nohistochemistry, and Western blot and, functional analysis performed by transepithelial resistance measurement and per-meability studies. Results: Increased plasma LPS, LBP levels and higher numbers of duodenal CD33 + /CD14 + /Trem-1 + macrophages, synthesizing iNOS and secreting NO were present in decompensated cirrhosis. Upregulation of IL-8, CCL2, CCL13 at the transcriptional level, and increased IL-8, and IL-6 were detected in supernatant and serum in cirrhosis. IL-6 and IL-8 co-localised with iNOS + and CD68 + , but not with CD11c + cells. Electron microscopy demon-strated an intact epithelial barrier. Increased Claudin-2 was detected by Western blot and immunohistochemistry, while decreased transepithelial resistance and increased duodenal per-meability were detected in decompensated cirrhosis. Conclusions: Our study shows the presence of activated CD14 +-Trem-1 + iNOS + intestinal macrophages, releasing IL-6, NO, and increased intestinal permeability in patients with cirrhosis, sug-gesting that these cells may produce factors capable of enhancing permeability to bacterial products.

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Section: Discussionmentioning

confidence: 84%

Activated intestinal macrophages in patients with cirrhosis release NO and IL-6 that may disrupt intestinal barrier function

Plessis

Vanheel

Janssen

et al. 2013

Journal of Hepatology

153

123

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“…Infections caused by intestinal bacteria are common complications in patients with cirrhosis (8,30). Spontaneous bacterial peritonitis (SBP) and bacteremia are the most frequent and severe infections in such patients, with in-hospital mortality rates being 20 to 30% and the survival expectancy at 6 months being Ͻ50% (1,29,34).…”

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confidence: 99%

Genetic Diversity and Virulence Profiles of Escherichia coli Isolates Causing Spontaneous Bacterial Peritonitis and Bacteremia in Patients with Cirrhosis

et al. 2010

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Among patients with cirrhosis, infections caused by Escherichia coli organisms that translocate from the gut are a frequent and severe complication. One hundred ten E. coli isolates from 110 cirrhotic patients with spontaneous bacterial peritonitis and/or spontaneous bacteremia were characterized for their phylogenetic group and virulence genotype (34 extraintestinal virulence factor genes). Genetic relatedness was investigated by enterobacterial repetitive intergenic consensus sequence type 2 (ERIC-2) PCR typing and multilocus sequence typing. Phylogenetic groups A, B1, B2, and D accounted for 24%, 4%, 48%, and 24% of the population, respectively. Overall, 68 distinct ERIC-2 profiles were encountered. Eleven clonal groups, represented by multiple isolates (2 to 11) from the same sequence type (ST) or sequence type complex, were identified. These clonal groups accounted for 54 (49%) isolates overall. Membership in one of these clonal groups was more frequent among B2 isolates than non-B2 isolates (67% versus 32%, P < 0.001). The most frequent sequence types were ST95 (n ‫؍‬ 13) and ST73 (n ‫؍‬ 8), followed by the ST14 and ST10 complexes (n ‫؍‬ 7). ST131 and ST69 were represented by three isolates each. Clonal group-associated isolates exhibited a greater prevalence of 11 virulence genes, including pap elements, than the other isolates. However, no association between clonal groups and host factors, type of infection, or mortality was observed. In conclusion, E. coli isolates causing spontaneous bacterial peritonitis and bacteremia in cirrhotic patients are genetically diverse. However, approximately half of the isolates belong to familiar clonal groups and exhibit extensive virulence profiles that may be associated with greater invasive potential.Infections caused by intestinal bacteria are common complications in patients with cirrhosis (8, 30). Spontaneous bacterial peritonitis (SBP) and bacteremia are the most frequent and severe infections in such patients, with in-hospital mortality rates being 20 to 30% and the survival expectancy at 6 months being Ͻ50% (1, 29, 34). Increasing evidence indicates that these infections result from bacterial translocation (BT) from the intestinal lumen to the mesenteric lymph nodes, combined with failure of host defense mechanisms to clear the translocating organisms (8, 37). BT is also associated with activation of the immune system and hyperdynamic circulatory status in cirrhosis, thereby contributing to the development of ascites and hepatorenal syndrome (37). The presence of bacterial DNA in the blood or ascitic fluid of uninfected patients, considered a surrogate marker of BT, has been shown to predict decreased 1-year survival (38). Given the key role of BT in cirrhosis, it is not surprising that Escherichia coli, which within the intestinal microflora is both the predominant facultative organism and the most adept at translocating to mesenteric lymph nodes (33), is also the most frequent agent of bacteremia and SBP in cirrhotic patients.Most extraintestinal E. coli str...

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“…(2) In cirrhotic patients, intestinal bacterial overgrowth and increased intestinal permeability contribute to bacterial translocation from the intestines more easily than in normal hosts. (28)(29)(30)(31)(32) The concomitant presence of impaired phagocytosis, poor opsonisation capacity, impaired reticuloendothelial system and low complement levels in cirrhotic patients (33)(34)(35)(36)(37) makes them all the more prone to bacteraemia. (38)(39)(40) Kuo et al reported that the frequencies of bacteraemia were positively correlated to the severity of liver cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Liver cirrhosis as a real risk factor for necrotising fasciitis: a three-year population-based follow-up study

Hung¹,

Tsai²,

Tseng³

et al. 2014

smedj

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RESULTSDuring the three-year follow-up period, there were 299 (0.7%) cirrhotic patients with NF and 160 (0.4%) non-cirrhotic patients with NF. Cox regression analysis showed that liver cirrhosis was a risk factor for the occurrence of NF during the study period (hazard ratio 1.982; p < 0.001). Among cirrhotic patients, those with complicated liver cirrhosis had a higher risk for the occurrence of NF than patients with non-complicated liver cirrhosis (hazard ratio 1.320; p = 0.028).CONCLUSION Cirrhotic patients had a higher risk for the occurrence of NF than non-cirrhotic patients, and the risk for NF was especially high among patients with complicated liver cirrhosis.

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The intestinal flora and bacterial infection in cirrhosis

Cited by 98 publications

References 170 publications

Activated intestinal macrophages in patients with cirrhosis release NO and IL-6 that may disrupt intestinal barrier function

Activated intestinal macrophages in patients with cirrhosis release NO and IL-6 that may disrupt intestinal barrier function

Genetic Diversity and Virulence Profiles of Escherichia coli Isolates Causing Spontaneous Bacterial Peritonitis and Bacteremia in Patients with Cirrhosis

Liver cirrhosis as a real risk factor for necrotising fasciitis: a three-year population-based follow-up study

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