scholarly journals Bacterial Infections in Cirrhosis

2004 ◽  
Vol 18 (6) ◽  
pp. 405-406 ◽  
Author(s):  
Guadalupe Garcia-Tsao
Keyword(s):  
Renal Failure ◽  
Bacterial Infections ◽  
Generation Cephalosporin ◽  
Variceal Hemorrhage ◽  
Bacterial Peritonitis ◽  
Increased Risk ◽  
Synthetic Function ◽  
Cirrhotic Patients ◽  
Tract Infections

Hospitalized patients with cirrhosis are at increased risk of developing bacterial infections, the most common being spontaneous bacterial peritonitis (SBP) and urinary tract infections. Independent predictors of the development of bacterial infections in hospitalized cirrhotic patients are poor liver synthetic function and admission for gastrointestinal hemorrhage. Short term (seven-day) prophylaxis with norfloxacin reduces the rate of infections and improves survival and should therefore be administered to all patients with cirrhosis and variceal hemorrhage. Cirrhotic patients who develop abdominal pain, tenderness, fever, renal failure or hepatic encephalopathy should undergo diagnostic paracentesis, and those who meet the criterion for SBP (eg, an ascites neutrophil count greater than 250/mm3) should receive antibiotics, preferably a third-generation cephalosporin. In addition to antibiotic therapy, albumin infusions have been shown to reduce the risk of renal failure and mortality in patients with SBP, particularly in those with renal dysfunction and hyperbilirubinemia at the time of diagnosis. Patients who recover from an episode of SBP should be given long term prophylaxis with norfloxacin and should be assessed for liver transplantation.

scholarly journals Epidemiology of hospital-acquired infections in cirrhotic patients: effect of carriage of methicillin-resistant Staphylococcus aureus and influence of previous antibiotic therapy and norfloxacin prophylaxis

2001 ◽  
Vol 127 (3) ◽  
pp. 443-450 ◽  
Author(s):  
B. CAMPILLO ◽  
C. DUPEYRON ◽  
J. P. RICHARDET
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Therapy ◽  
Generation Cephalosporin ◽  
Methicillin Resistant ◽  
Hospital Acquired Infections ◽  
Bacterial Peritonitis ◽  
Increased Risk ◽  
Cirrhotic Patients ◽  
Hospital Acquired ◽  
Prior Antibiotic Therapy

We assessed the prevalence of carriage of methicillin-resistant Staphylococcus aureus (MRSA) in anterior nares and stools, and of third-generation cephalosporin resistant enterobacteriaceae and non-fermenting Gram-negative bacilli (RE/RNF) in stools of 748 hospitalized long-stay cirrhotic patients. We also evaluated the consequences of carriage on the epidemiology of hospital-acquired spontaneous bacterial peritonitis, bacteraemia and urinary tract infection (UTI) in these patients. The prevalence of carriage of MRSA and RE/RNF was 16·7% and 14·7% respectively. Whereas RE/RNF carriage did not lead to an increased risk of infection due to RE/RNF, the overall risk of infections caused by MRSA was more than tenfold higher in MRSA carriers. MRSA and RE/RNF carriers had received prior antibiotic therapy to a greater extent than non-carriers (P < 0·001) and MRSA carriers had received prior norfloxacin prophylaxis to a greater extent than the two other groups (P < 0·02). The mortality rate during hospital stay was higher in MRSA and RE/RNF carriers than in non-carriers (P < 0·001). Pugh score (P < 0·0001), age (P < 0·0001), MRSA carriage (P = 0·0018) and bacteraemia (P = 0·0017) were associated independently with mortality. MRSA carriage in hospitalized cirrhotic patients leads to the emergence of infections due to this strain, mainly SBP and bacteraemia. Prior antibiotic therapy and norfloxacin prophylaxis increase the risk of carriage of MRSA.

scholarly journals Bacterial infections in patients with liver cirrhosis

2011 ◽  
Vol 2 (3) ◽  
pp. 147-159
Author(s):  
Giacomo Zaccherini ◽  
Vittoria Bevilacqua ◽  
Barbara Benazzi ◽  
Lucia Santi ◽  
Paolo Caraceni ◽  
...  
Keyword(s):  
Renal Failure ◽  
Liver Cirrhosis ◽  
Bacterial Infections ◽  
Human Albumin ◽  
Multiple Organ ◽  
Clinical Factor ◽  
Systemic Complications ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients ◽  
Unfavourable Prognosis

Bacterial infections represent a frequent complication of liver cirrhosis carrying a significantly greater risk of morbidity and mortality as compared to that observed in non-cirrhotic patients. Such unfavourable prognosis is related to the systemic complications (liver and renal failure, shock, coagulopathy, multiple organ failure) induced by a series of pro-inflammatory and immunological systems which are activated by bacteria and their pathogenetic products.The epidemiology of bacterial infections in cirrhosis has changed in the last years with a marked increase of Gram+ infections and the emergence of multi-resistant bacteria.The severity of liver disease represents the major clinical factor predisposing to bacterial infections, which are asymptomatic or paucisymptomatic at presentation in almost half of the cases. Aim of this review is to summarise the clinical and therapeutic aspects of bacterial infections in cirrhotic patients. The most common sites of infection are the urinary tract, ascites, blood, lungs and soft tissues.Beside antibiotics, it has been proposed the administration of human albumin to prevent the development of renal failure in patients with spontaneous bacterial peritonitis and, more recently, the use of hydrocortisone to treat cirrhotic patients with septic shock.

Treatment of Spontaneous Bacterial Peritonitis

2015 ◽  
Vol 33 (4) ◽  
pp. 582-585 ◽  
Author(s):  
Francesco Salerno ◽  
Vincenzo La Mura
Keyword(s):  
Renal Failure ◽  
Antibiotic Therapy ◽  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Hepatorenal Syndrome ◽  
Refractory Ascites ◽  
Bacterial Peritonitis ◽  
Risk Of Death ◽  
Tract Infections

Spontaneous bacterial peritonitis (SBP) is an infection of patients with cirrhosis and ascites. This peculiarity is due to the frequent intestinal translocation that allows bacteria to cross the intestinal barrier, colonizing the ascitic fluid. In cirrhosis, SBP is inferior only to urinary tract infections. It is prevalently sustained by Gram-negative bacteria such as Escherichia coli and Klebsiella. Risk factors for developing SBP are advanced age, refractory ascites, variceal bleeding, renal failure, low albumin levels (below 2.5 g/ml), bilirubin over 4 mg/dl, Child-Pugh class C and a previous diagnosis of SBP. Thus, this is an indication for a long-term antibiotic prophylaxis with norfloxacin. Renal failure - especially the hepatorenal syndrome - complicates SBP in about 20% of cases independently of the efficacy of the antibiotic therapy. The mortality of these patients is about 90%. Infusion of albumin significantly reduces the incidence of hepatorenal syndrome and consequently the risk of death. Long-term quinolonic prophylaxis as well as increased antibiotic therapies are causing the emergence of multidrug-resistant agents as frequent causes of SBP. In such cases, the antibiotic sensitivity to quinolones is low, and European recommendations suggest a second-line antibiotic therapy, including meropenem or piperacillin plus tazobactam. Collection of blood, urine and ascitic fluid for cultures is important for bacterial recognition, possibly before starting an empirical antibiotic therapy. Indeed, the probability of positive cultures rapidly vanishes when they are performed during already implemented antibiotic administration. It is important to know that a failure of the first-line therapy is associated with an increased probability of death.

scholarly journals Bacterial infections in patients with liver cirrhosis

2011 ◽  
Vol 2 (3) ◽  
pp. 147
Author(s):  
Giacomo Zaccherini ◽  
Vittoria Bevilacqua ◽  
Barbara Benazzi ◽  
Lucia Santi ◽  
Paolo Caraceni ◽  
...  
Keyword(s):  
Renal Failure ◽  
Liver Cirrhosis ◽  
Bacterial Infections ◽  
Human Albumin ◽  
Multiple Organ ◽  
Clinical Factor ◽  
Systemic Complications ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients ◽  
Unfavourable Prognosis

Bacterial infections represent a frequent complication of liver cirrhosis carrying a significantly greater risk of morbidity and mortality as compared to that observed in non-cirrhotic patients. Such unfavourable prognosis is related to the systemic complications (liver and renal failure, shock, coagulopathy, multiple organ failure) induced by a series of pro-inflammatory and immunological systems which are activated by bacteria and their pathogenetic products.The epidemiology of bacterial infections in cirrhosis has changed in the last years with a marked increase of Gram+ infections and the emergence of multi-resistant bacteria.The severity of liver disease represents the major clinical factor predisposing to bacterial infections, which are asymptomatic or paucisymptomatic at presentation in almost half of the cases. Aim of this review is to summarise the clinical and therapeutic aspects of bacterial infections in cirrhotic patients. The most common sites of infection are the urinary tract, ascites, blood, lungs and soft tissues.Beside antibiotics, it has been proposed the administration of human albumin to prevent the development of renal failure in patients with spontaneous bacterial peritonitis and, more recently, the use of hydrocortisone to treat cirrhotic patients with septic shock.

scholarly journals Listeria monocytogenes peritonitis in cirrhotic patients: first description in Brazil

2006 ◽  
Vol 48 (5) ◽  
pp. 291-293 ◽  
Author(s):  
Marcos Tadashi Kakitani Toyoshima ◽  
André Apanavicius ◽  
Alexandre de Matos Soeiro ◽  
Gisele Madeira Duboc de Almeida ◽  
Milton Hideaki Arai
Keyword(s):  
Listeria Monocytogenes ◽  
Hepatic Cirrhosis ◽  
Generation Cephalosporin ◽  
Secondary Prophylaxis ◽  
Common Complication ◽  
Bacterial Peritonitis ◽  
Appropriate Treatment ◽  
Listeria Monocytogenes Infection ◽  
Cirrhotic Patients ◽  
Adequate Coverage

Two cases of spontaneous bacterial peritonitis (SBP) caused by Listeria monocytogenes in cirrhotic patients are reported. In one of the cases, the microorganism was isolated from pleural effusion and ascites. SBP is a serious and common complication of patients with ascites caused by hepatic cirrhosis and the culture of the ascitic fluid is an important tool for the diagnosis and for the more appropriate treatment. Although a third generation cephalosporin has usually been employed for empiric treatment of SBP, it does not provide adequate coverage against Listeria spp. In such cases the use of ampicillin (with or without sulbactam) or sulfamethoxazole-trimethoprim is recommended. The last one is used for secondary prophylaxis, instead of norfloxacin. To summarize, Listeria monocytogenes infection is a rare cause of SBP, whose treatment should be specific for the bacteria.

scholarly journals High Prevalence of Multidrug Resistant Bacteria in Cirrhotic Patients with Spontaneous Bacterial Peritonitis: Is It Time to Change the Standard Antimicrobial Approach?

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Jerônimo De Conto Oliveira ◽  
Enrique Carrera ◽  
Roberta C. Petry ◽  
Caroline Deutschendorf ◽  
Augusto Mantovani ◽  
...  
Keyword(s):  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Generation Cephalosporin ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Bacterial Peritonitis ◽  
High Prevalence ◽  
Cirrhotic Patients ◽  
End Stage

Introduction. Spontaneous bacterial peritonitis (SBP) has a deleterious clinical impact in end-stage liver disease, and multidrug resistance has increased, raising concern about effectiveness of traditional antibiotic regimens. Patients and Methods. Single-center retrospective study of ascitic fluid infections in cirrhotic patients. Results. We analyzed medical records related to 2129 culture-positive ascitic fluid and found 183 samples from cirrhotic patients. There were 113 monobacterial SBP cases from 97 cirrhotic patients; 57% of patients were male; hepatitis C and alcohol were the main etiologies for cirrhosis. Multidrug resistant bacteria were isolated in 46.9% of SBP samples, and third-generation cephalosporin and quinolone resistant reached 38.9% and 25.7% of SBP cases. Conclusion. SBP due to multidrug resistant bacteria is a growing problem, and one should consider reported resistance profiles for the decision-making process of empirical first-line treatment prescription.

scholarly journals Bacterial infections in cirrhosis: a narrative review and key points for clinical practice

2020 ◽  
Vol 14 (3) ◽  
pp. 126-135
Author(s):  
Mario Mitra ◽  
Andrea Mancuso ◽  
Flavia Politi ◽  
Alberto Maringhini
Keyword(s):  
Antibiotic Resistance ◽  
Bacterial Infections ◽  
Empirical Therapy ◽  
Multidrug Resistant ◽  
High Rate ◽  
First Episode ◽  
Bacterial Peritonitis ◽  
Prophylactic Measures ◽  
Tract Infections ◽  
Healthcare Associated

Bacterial infections are frequent complications of liver cirrhosis, accounting for severe clinical courses, and increased mortality. The reduction of the negative clinical impact of infections may be achieved by a combination of prophylactic measures to reduce the occurrence, early identification, and management. Spontaneous bacterial peritonitis (SBP), urinary tract infections, pneumonia, cellulitis, and spontaneous bacteremia are frequent in cirrhosis. The choice of initial empirical antimicrobial therapy should be based on both site, severity, and origin of infection (community-acquired, nosocomial, or healthcare-associated) and on antibiotic resistance patterns. 3rd generation cephalosporins are generally indicated as empirical therapy in most community-acquired cases. However, for nosocomial and healthcare-associated infections, due to a high rate of multidrug-resistant (MDR) pathogens, a broader spectrum treatment is appropriate. In order to prevent antibiotic resistance emergence, microbiological cultures should be collected, and a de-escalation applied when antimicrobial susceptibility tests are available. Standard measures to prevent infections and the identification of carriers of MDR bacteria are essential strategies to prevent infections in cirrhosis. Antibiotic prophylaxis should be applied only to gastrointestinal bleeding, SBP recurrence prevention, and cirrhotics at high risk of a first episode of SBP.

scholarly journals Procalcitonin: A Key Marker in Children with Urinary Tract Infection

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Sandrine Leroy ◽  
Alain Gervaix
Keyword(s):  
Urinary Tract ◽  
Bacterial Infections ◽  
Renal Scarring ◽  
Clinical Decision ◽  
Common Source ◽  
High Grade ◽  
Dmsa Scan ◽  
Reliable Marker ◽  
Tract Infections

Urinary tract infections (UTIs) are the most common source of bacterial infections among young febrile children. Accurate diagnosis of acute pyelonephritis (APN) and vesicoureteral reflux (VUR) is important because of their association with renal scarring, leading in the cases to long-term complications. However, the gold standard examinations for both are either DMSA scan (for APN and scar) or cystography (for VUR) and present limitations (feasibility, pain, cost, etc.). Procalcitonin, a reliable marker of bacterial infections, was demonstrated to be a good predictor of both renal parenchymal involvement in the acute phase and late renal scars. Furthermore, it was also found to be associated with high-grade VUR and was the key tool of a clinical decision rule to predict high-grade VUR in children with a first UTI. Therefore, procalcitonin may certainly be found playing a role in the complex and still debated picture of which examination should be performed after UTI in children.

scholarly journals Diagnosis and Management of Pediatric Urinary Tract Infections

2005 ◽  
Vol 18 (2) ◽  
pp. 417-422 ◽  
Author(s):  
Joseph J. Zorc ◽  
Darcie A. Kiddoo ◽  
Kathy N. Shaw
Keyword(s):  
Urinary Tract ◽  
Bacterial Infections ◽  
Test Results ◽  
Prevalence Studies ◽  
Diagnosis And Management ◽  
Appropriate Treatment ◽  
Tract Infections ◽  
The Cost ◽  
Emergence Of Resistance

SUMMARY Urinary tract infection (UTI) is among the most commonly diagnosed bacterial infections of childhood. Although frequently encountered and well researched, diagnosis and management of UTI continue to be a controversial issue with many challenges for the clinician. Prevalence studies have shown that UTI may often be missed on history and physical examination, and the decision to screen for UTI must balance the risk for missed infections with the cost and inconvenience of testing. Interpretation of rapid diagnostic tests and culture is complicated by issues of contamination, false test results, and asymptomatic colonization of the urinary tract with nonpathogenic bacteria. The appropriate treatment of UTI has been controversial and has become more complex with the emergence of resistance to commonly used antibiotics. Finally, the anatomic evaluation and long-term management of a child after a UTI have been based on limited evidence, and newer studies question some of the tenets of prior recommendations. The goal of this review is to provide an up-to-date summary of the literature with particular attention to practical questions about diagnosis and management for the clinician.

scholarly journals Pharmacotherapy of liver cirrhosis and its complications

2021 ◽  
pp. 23-27
Author(s):  
T. M. Bentsa
Keyword(s):  
Liver Cirrhosis ◽  
Spontaneous Bacterial Peritonitis ◽  
Hepatorenal Syndrome ◽  
Beta Blockers ◽  
Bleeding Risk ◽  
Refractory Ascites ◽  
Variceal Hemorrhage ◽  
Bacterial Peritonitis ◽  
Treatment And Prevention ◽  
Increased Risk

This article provides information about the pharmacotherapy of liver cirrhosis (LC) and its complications, such as variceal hemorrhage, ascites, increased risk of bacterial infection, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome LC is a major healthcare problem and is associated with an increased mortality due to the development of complications. LC is currently the 11th most common cause of death globally. Prognosis of LC is highly variable and influenced by several variables, such as etiology, severity of liver disease, presence of complications and comorbidities. In advanced cirrhosis, survival decreases to one or two years. Pharmacotherapy for LC should be implemented in accordance with up-to-date guidelines and in conjunction with aetiology management, nutritional optimisation and patient education. The main treatment of uncomplicated ascites is diuretics such as spironolactone in combination with a loop diuretic. For treatment refractory ascites vasoconstrictors and albumin are recommended. Antibiotics play a well-established role in the treatment and prevention of spontaneous bacterial peritonitis. For hepatorenal syndrome, the administration of vasopressor terlipressin and albumin is recommended. Endoscopic treatment is used for variceal bleeding (for example, ligation for esophageal varices and tissue glue for gastric varices). A shunt (TIPS) is used to treat severe or repeat variceal hemorrhage or refractory ascites. Non-selective beta-blockers effectively reduce variceal re-bleeding risk in LC patients with moderate/large varices. Thus, the treatment of LC as one of the most formidable multiorgan pathologies involves a comprehensive approach aimed at the correction of the main pathology and the treatment and prevention of its complications.

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