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Abstract Details
Bacterial Infections in Cirrhosis. A Position Statement based on the EASL Special Conference 2013
Author information
1Liver Failure Group, UCL Institute for Liver and Digestive Health, Royal Free Hospital, UK.
2Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
3Department Gastroenterology, UVCM, Inselspital, 3010 Bern, Switzerland.
4Department of Medicine, University of California San Diego, La Jolla, CA;USA.
5INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, UMRS 773, Université Paris-Diderot Paris, Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.
6Unit of Hepatic Emergencies and Liver Transplantation, Dept of Medicine, University of Padova, Italy.
7Department of Internal Medicine, Division of Gastroenterology und Hepatology, Medical University of Graz, Austria.
8Department of Gastroenterology and Hepato-Pancreatology, Erasme Hospital, Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium.
9Department of Medical and Surgical Sciences - University of Bologna, Italy.
10Dept of Microbiology.HospitalUniversitario Ramón y Cajal and Intituto Ramon y Cajal de Investigación Sanitaria (IRYCIS).Madrid, Spain.
11Gastroenterology Service, University Hospital Ramon y Cajal, Madrid, Spain.
12Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
13Medical Intensive Care Unit, University Hospital Gasthuisberg, Leuven, Belgium.
14Department of Microbiology, Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain.
15Institute of Liver Studies and Critical Care, Kings college London, Kings college hospital, UK.
16Department of Clinical Medicine, Miguel Hernández University, Alicante, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
17Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona;CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
18Charles Caravati Professor of Medicine, Dept of internal medicine, Virginia Commonwealth University School of Medicine, Richmond, VA. USA.
19Department of Medicine Section of Digestive Diseases, Yale University School of Medicine New Haven CT. USA.
20The Royal Free Shelia Sherlock Liver Centre and University Dept of Surgery, University College London and Royal Free Hospital.
21Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: pgines@clinic.ub.es.
Abstract
Bacterial infections are very common and represent one of the most important reasons of progression of liver failure, development of liver-related complications, and mortality in patients with cirrhosis. In fact, bacterial infections may be a triggering factor for the occurrence of gastrointestinal bleeding, hypervolemic hyponatremia, hepatic encephalopathy, kidney failure, and development of acute-on-chronic liver failure. Moreover, infections are a very common cause of repeated hospitalizations, impaired health-related quality of life, and increased healthcare costs in cirrhosis. Bacterial infections develop as a consequence of immune dysfunction that occurs progressively during the course of cirrhosis. In a significant proportion of patients, infections are caused by gramnegative bacteria from intestinal origin, yet grampositive bacteria are a frequent cause of infection, particularly in hospitalized patients. In recent years, infections caused by multidrug-resistant bacteria are becoming an important clinical problem in many countries. The reduction of the negative clinical impact of infections in patients with cirrhosis may be achieved by a combination of prophylactic measures, such as administration of antibiotics, to reduce the occurrence of infections in high-risk groups together with early identification and management of infection once it has developed. Investigation on the mechanisms of altered gut microflora, translocation of bacteria, and immune dysfunction may help develop more effective and safe methods of prevention compared to those that are currently available. Moreover, research on biomarkers of early infection may be useful in early diagnosis and treatment of infections. The current manuscript reports and in-depth review and a position statement on bacterial infections in cirrhosis.