Bacterial Infections In Cirrhosis Research Articles

Prophylaxis and Treatment of Bacterial Infections in Cirrhosis

Prophylaxis and Treatment of Bacterial Infections in Cirrhosis

Impact of multidrug resistance on the management of bacterial infections in cirrhosis.

Patients with cirrhosis have an increased risk of infection and differently from other complications, that over the years are improving in their outcomes, infections in cirrhotic patients are still a major cause of hospitalization and death (up to 50% in-hospital mortality). Infections by multidrug-resistant organisms (MDRO) have become a major challenge in the management of cirrhotic patients with significant prognostic and cost-related impact. About one third of cirrhotic patients with bacterial infections is infected with MDR bacteria and their prevalence has increased in recent years. MDR infections have a worse prognosis compared to infections by non-resistant bacteria because they are associated with lower rate of infection resolution. An adequate management of cirrhotic patients with infections caused by MDR bacteria depends on the knowledge of some epidemiological aspects, such as the type of infection (spontaneous bacterial peritonitis, pneumonia, urinary tract infection and spontaneous bacteremia), bacteriological profile of antibiotic resistance at each health care unit and site of infection acquisition (community acquired, healthcare associated or nosocomial). Furthermore, regional variations in the prevalence of MDR infections determine that the choice of empirical antibiotic therapy must be adapted to the local microbiological epidemiology. Antibiotic treatment is the most effective measure to treat infections caused by MDRO. Therefore, optimizing antibiotic prescribing is critical to effectively treat these infections. Identification of risk factors for multidrug resistance is essential to define the best antibiotic treatment strategy in each case and the choice of an effective empirical antibiotic therapy and its early administration is cardinal to reduce mortality. On the other hand, the supply of new agents to treat these infections is very limited. Thus, specific protocols that include preventive measures must be implemented in order to limit the negative impact of this severe complication in cirrhotic patients.

Bacterial infections in cirrhosis of liver patients; its association with organ failure/outcome

Bacterial infections in cirrhosis of liver patients; its association with organ failure/outcome

OS087 - Bacterial infections in cirrhosis are associated with reduction in gut microbial phage-bacterial interactions

OS087 - Bacterial infections in cirrhosis are associated with reduction in gut microbial phage-bacterial interactions

Immunosuppression and Increased Risk of Bacterial Infections in Cirrhosis

Immunosuppression and Increased Risk of Bacterial Infections in Cirrhosis

The role of Gram-positive and drug-resistant bacteria in bacterial infections in cirrhosis

The role of Gram-positive and drug-resistant bacteria in bacterial infections in cirrhosis

Bacterial Infections in Cirrhosis

Abstract Bacterial infections are the most common trigger of acute decompensation of cirrhosis. The occurrence of infections in cirrhosis is associated with the development of organ dysfunctions, failures, and acute on chronic liver failure. The combination of infections and organ dysfunction/acute on chronic liver failure dramatically increases the mortality risk in these patients. Infections in cirrhosis are a big challenge for clinicians, since the mortality from sepsis is increasing in these patients worldwide. The rapid and progressive spread of multiresistant bacteria has been blamed for the increased mortality rate. Several studies have shown that early diagnosis and appropriate administration of antibiotic treatment are crucial for improving prognosis in these patients. Moreover, the prevention and treatment of acute kidney injury and organ failures are fundamental parts of management of infections in cirrhosis. Herein we provided a concise and updated review of the literature on bacterial infections in patients with cirrhosis.

Frequency of Spontaneous Bacterial Peritonitis in Cirrhosis of Liver in Department of Medicine at People Medical College Hospital Nawabshah Pakistan

Introduction: Bacterial Infections in cirrhosis of liver is one of the main complications with increase mortality rate. Infection of ascitic fluid in cirrhosis of liver was introduced by Conn and fessel [2], termed as spontaneous bacterial peritonitis.
 Objective: To determine the frequency of Spontaneous Bacterial Peritonitis (SBP) in patients presenting with cirrhosis of liver.
 Methodology: It is a descriptive cross-sectional study which was performed in the Medicine Ward at People’s Medical College Hospital Nawabshah Pakistan from 1st June 2018 to 31 July 2020. Total 100 admitted patients were selected for this study, male patient were 58 and female patient were 42. Consent was taken from the patients and their relatives. Primary and secondary outcomes measured. All the patients with diagnosis of cirrhosis of liver were included for this study, ascites due to other causes and patients on antibiotic therapy were excluded from this study. Ascitic fluid aspirated for culture and DR. Blood CP, Urea, Creatinine, LFT and PT was performed.
 Results: Among these 100 patients 13 were culture positive raised ascites PMN, 17 were culture negative raised ascites PMN. E. coli was detected in majority of the culture positive patients. 70 patients presented with sterile ascites. SBP patients presented with fever, abdominal pain, jaundice, Encephalopathy and raised prothrombin time.
 Conclusion: SBP common complication of cirrhosis associated with high mortality. All cirrhotic Patients admitted in medical wards with history of abdominal pain, fever and Encephalopathy, diagnostic paracentesis is compulsory. Early management with intravascular expansion with albumin and antibiotics with good prognosis mortality can be reduced.

Increased sTREM-1 levels identify cirrhotic patients with bacterial infection and predict their 90-day mortality

Background and aimsPatients with cirrhosis are susceptible to bacterial infections (BIs) that are major causes of specific complications and mortality. However, the diagnosis of BIs can often be difficult in advanced disease stage since their symptoms may overlap with the ones of acute decompensation (AD). Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is released from monocytes/macrophages and neutrophils during activation and has been reported to correlate with activity of various inflammatory processes. We investigated its diagnostic and prognostic performance in patients with cirrhosis and BI. MethodsSera of 269 patients were assayed for sTREM-1 by ELISA (172 outpatients and 97 patients with AD of whom 56 had BI). We investigated capacity of sTREM-1 to identify patients with BI and conducted a 90-day follow-up observational study to assess its possible association with short-term mortality. ResultssTREM-1 levels were significantly higher in patients with more severe liver disease, BI, and acute-on-chronic liver failure than in patients without these conditions. sTREM-1 had similar accuracy to CRP identifying BI [sTREM-1: AUROC (95%CI) 0.804 (0.711−0.897), p < 0.0001; CRP: 0.791 (0.702−0.881), p < 0.0001)] among AD patients. The combination of these two molecules and the presence of ascites into a composite score significantly increased their discriminative power (AUROC: 0.878, 95%CI: 0.812−0.944, p < 0.0001). High sTREM-1 level (>660 pg/mL) was an independent predictor of 90-day mortality in patients with BI [HR: 2.941, (95%CI: 1.009−8.573), p = 0.048] in our multivariate model. ConclusionsUse of sTREM-1 could increase the recognition of BIs in cirrhosis and help clinicians in mortality risk assessment of these patients.

Changes in the epidemiology and management of bacterial infections in cirrhosis.

Patients with cirrhosis are susceptible to develop infections because of immune dysfunction, changes in microbiome and increase in bacterial translocation from the gut to systemic circulation. Bacterial infections can worse the clinical course of the disease, triggering the development of complications such as acute kidney injury, hepatic encephalopathy, organ failures and acute on chronic liver failure. In recent years, the spread of multi drug resistant bacteria made more challenging the management of infections in patients with cirrhosis. Hence, the mortality rate associated to sepsis is increasing in these patients. Therefore, the optimization of the management of infections has a high priority in cirrhosis. Herein we reviewed the recent changes in the epidemiology and the management of bacterial infections in patients with liver cirrhosis.

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

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.

Prophylactic Antibiotics in Cirrhosis: Are They Promoting or Preventing Infections?

Prophylactic Antibiotics in Cirrhosis: Are They Promoting or Preventing Infections?

Bacterial infections in cirrhosis of liver: a hospital based study

Bacterial infections in cirrhosis of liver: a hospital based study

Common NOD2 Risk Variants as Major Susceptibility Factors for Bacterial Infections in Compensated Cirrhosis.

OBJECTIVES:Common nucleotide-binding oligomerization domain containing 2 (NOD2) gene variants have been associated with bacterial infections (BIs) in cirrhosis, in particular, spontaneous bacterial peritonitis, and mortality. Our aim was to evaluate the independent association of NOD2 variants with BI according to the decompensation stage.METHODS:Consecutive patients with cirrhosis in 2 academic medical centers were included and genotyped for the NOD2 variants p.R702W, p.G908R, and c.3020insC. Electronic medical records were screened for BI (requiring antibiotic therapy) and past and present decompensation (as defined by variceal bleeding, encephalopathy, ascites, and/or jaundice). Clinically significant portal hypertension (CSPH) was assessed with liver stiffness and/or hepatic venous pressure gradient measurements.RESULTS:Overall, 735 patients were recruited (men 65%; interquartile age range 53–68 years). Alcoholic cirrhosis was the predominant etiology (n = 406, 55%), and most patients were in the decompensated stage (n = 531, 72%). In total, 158 patients (21%) carried at least one NOD2 variant. BIs were detected in 263 patients (36%), and NOD2 variants were associated with BI (odds ratio = 1.58; 95% confidence interval 1.11–2.27; P = 0.02). In compensated patients, the combination of NOD2 variants and presence of CSPH was the best independent predictors of BI, whereas other factors, such as spleen size and hemoglobin, and decompensations including hepatic encephalopathy or jaundice, gained relevance in decompensated patients.CONCLUSIONS:NOD2 risk variants are associated with BI in cirrhosis. The genetic effect on BI is strongest in compensated patients, whereas in decompensated patients their presence is less relevant. In this situation, CSPH becomes an independent factor associated with BI.

59. Trend of bacterial infections in cirrhosis in a tertiary care centre

Background and Aims: Patients with liver cirrhosis have a high susceptibility for bacterial infections and multidrug resistant infections can result in a rapidly downhill course. Identifying the organism early in the course might be essential to salvage these patients. We aim to study the clinical profile of most common infections in patients with liver cirrhosis in our tertiary care referral center and set up an antibiotic profile Methods: This is a single centre retrospective analysis of prospectively collected data at a tertiary referral centre. The study was conducted in the Institute of Hepatobiliary Sciences, Madras Medical College, Chennai. The study includes 107 patients evaluated for a period of eight months- June 2017 to January 2018. Results: The study included 107 patients with cirrhosis. The most common site of infection was urinary tract followed by blood stream infections and spontaneous bacterial peritonitis. The most common organisms found were Escherichia coli in blood stream infections. Klebsiella followed by enterococcus were prevalent in UTIs. Candiduria was found in one subset of patients with prolonged intensive care unit stay. The most common culturable organism in the urine was Klebsiella of which 40% proved to be multi-drug resistant. Apart from those attributed to nosocomial acquisition, MDR Klebsiella was found in patients with remote hospital admissions, which led to the suspicion of a possible colonic carrier state. Conclusions: This subset of patients may need a more extensive initial empiric antibiotic regimen. To define this subset of patients we plan to advocate rectal swab cultures in those with recurrent in-hospital admissions The authors have none to declare.

SAT-194 - Acellular growth retardation ability (AGRA), a novel biomarker for humoral immune function, predicts the occurrence of severe bacterial infections in cirrhosis

SAT-194 - Acellular growth retardation ability (AGRA), a novel biomarker for humoral immune function, predicts the occurrence of severe bacterial infections in cirrhosis

SAT-253 - Functional polymorphisms of innate immunity receptors are not risk factors for non-SBP type bacterial infections in cirrhosis

SAT-253 - Functional polymorphisms of innate immunity receptors are not risk factors for non-SBP type bacterial infections in cirrhosis

Functional polymorphisms of innate immunity receptors are not risk factors for the non-SBP type bacterial infections in cirrhosis.

Pattern recognition receptors (PRRs) have a key role in the innate host defense. Functional polymorphisms of various PRRs have been established to contribute to an increased susceptibility to spontaneous bacterial peritonitis (SBP). Their role in the development of cirrhosis-associated bacterial infections (BI), beyond SBP or progressive disease course related to pathological bacterial translocation (BT) remains unknown. Three hundred and forty-nine patients with cirrhosis were genotyped for common NOD2 (R702W, G908R and L1007PfsinsC), TLR2 (-16934T>A), and TLR4 (D299G) variants. Incidence of BIs, decompensating events and liver-related death were assessed in a 5-year follow-up observational study. Pathological BT was assessed based on the presence of antimicrobial antibodies or lipopolysaccharide-binding protein (LBP) level. In patients with ascites (n=88) only NOD2 gene variants were associated with an increased cumulative probability of SBP (76.9%±19.9%) compared to wild-type (30.9%±6.9%, PLogRank =.047). Individual or combined PRR genetic profiles were associated with the risk of non-SBP type BI. Advanced disease stage (HR [95% CI]: 2.11 [1.38-3.25]) and prior history of a BI episode (HR: 2.42 [1.58-3.72]) were the major clinical risk factors of a subsequent BI. The risk of a non-SBP type BI in patients with advanced disease and a prior BI was even higher (HR: 4.74 [2.68-8.39]). The frequency of antimicrobial antibodies and LBP levels did not differ between various PRR genotypes. Correspondingly, PRR genetic profile was not able to predict the long-term disease course. In cirrhosis, functional polymorphisms of PRRs did not improve the identification of patients with high risk of BI beyond SBP or progressive diseases course.

C-Reactive Protein and Resistin Detect Bacterial Infections in Liver Cirrhosis

Introduction: Bacterial infection usually has poor outcome, but often full of diagnostic difficulties in cirrhotic patients. The role of clinical parameters such as systemic inflammatory response syndrome, leukocyte count, neutrophil count, and other markers remains unclear in liver cirrhosis patients. The aim of this study was to evaluate the usefulness of inflammatory markers and determined which markers were best for the diagnosis of infection in decompensated cirrhotic patients. Methods: This was a diagnostic study consisted of 80 cirrhotic patients admitted to Sanglah general hospital, Denpasar from August 2014 until July 2015. Prospective study was designed. Markers of infection consist of leukocyte count, neutrophil count, neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP) and resistin were measured. Accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined. Results: Bacterial infections were noted in twenty patients (25%) and spontaneous bacterial peritonitis (SBP) was the most common infections occurred. NLR, CRP, and resistin were higher in bacterial infections group (p < 0.05). Multiple logistic regression analyses showed that CRP and resistin were predictive factor for occurrence of bacterial infections (p < 0.05). For the diagnosis of infection, baseline CRP - using a 11.65 mg/L cut-off value - and resistin - using a 13 ng/mL cut-off value - generated area under the receiver operating characteristic (ROC) curve of 0.796 and 0.787, respectively. The sensitivity, specificity, PPV, and NPV for CRP were 90%, 73%, 52.9%, and 95.7%, respectively. For resistin, the sensitivity, specificity, PPV, and NPV were 90%, 59%, 41.9%, and 94.6% respectively. Conclusion: In the present study, CRP level of 11.65 mg/L or resistin 13 ng/mL seem adequate in rule out infections. Pieri et al in 2014 found out that CRP is still reliable in prediction of bacterial infection in cirrhosis. Johansson et al stated that resistin increase in noncirrhotic patients with severe sepsis. Currently there are no data on resistin levels in cirrhotic patients with bacterial infections. This study showed that resistin may have role in bacterial infections. In conclusion, resistin and CRP showed good accuracy as screening tests in diagnosing bacterial infection in cirrhotic patients. In the future, these modalities may aid clinician in predicting which patient more likely to have infections.Figure: Distribution of the serum concentration of resistin (A), C-reactive protein (CRP) (B), and neutrophil-lymphocyte ratio (NLR) (C) in liver cirrhosis patients with or without infections.Figure: ROC curves of CRP and resistin for the diagnosis of infection at admission.Table: Table. Diagnostic accuracy of C-reactive protein and resistin in diagnosing infection in liver cirrhosis.

Spectrum of Bacterial Infections in Cirrhosis of Liver in A Resource Constrained Region

Spectrum of Bacterial Infections in Cirrhosis of Liver in A Resource Constrained Region