[TREATMENT AND PREVENTION OF BACTERIAL AND MYCOTICINFECTION IN ACUTE LIVER FAILURE]

Area of Science:

• Infectious Diseases
• Hepatology
• Critical Care Medicine

Background:

• Patients with acute liver failure (ALF) exhibit profound immune dysfunction, increasing susceptibility to nosocomial and opportunistic infections.
• Infections, particularly pneumonia, are frequent early complications in ALF, often presenting without classic signs like fever or elevated white blood cell (WBC) counts.
• Up to 80% of ALF patients experience bacteriologically proven infections, with fungal infections occurring in 32%.

Purpose of the Study:

• To evaluate the efficacy of selective parenteral and enteral antisepsis regimens (SPEAR) in reducing infection episodes in ALF patients.
• To assess the impact of antimicrobial prophylaxis on infectious complications and mortality in acute liver failure.

Main Methods:

• Review of prospective controlled studies evaluating antimicrobial prophylaxis strategies, including SPEAR.
• Analysis of infection rates, types of infections (bacterial and fungal), and clinical presentation in ALF patients.
• Comparison of outcomes between prophylactic systemic antibacterials and oral non-absorbable antibacterials.

Main Results:

• Initial studies indicated an overall reduction in infection episodes with SPEAR.
• Recent findings suggest that oral non-absorbable antibacterials offer no additional benefit over prophylactic systemic antibacterials.
• Pneumonia is the most common infection, occurring in 50% of episodes, often early in the disease course.

Conclusions:

• Antimicrobial prophylaxis is essential for reducing infectious complications in acute liver failure.
• Prophylactic strategies significantly contribute to improving mortality rates in ALF patients.
• The absence of typical infection signs (fever, high WBC) in 30% of ALF patients underscores the need for vigilant monitoring and prophylaxis.