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Bacterial infections in cirrhosis
Gregory J Botwin1,2, Timothy R Morgan3,4
1Gastroenterology Services, VA Long Beach Healthcare Group-11 (GI), VA Long Beach Healthcare System, 5901 E. Seventh Street, Long Beach, CA, 90822, USA.
Abstract:
Bacterial infections occur in 25-35 % of cirrhotics admitted to hospital. Health-care associated and hospital acquired (nosocomial) infections are the most common epidemiology, with community acquired infections less common (15-30 %). Spontaneous bacterial peritonitis and urinary infections are the most common sites, with spontaneous bacteremia, pneumonia, cellulitis and other sites being less common. The risk of infection is increased among subjects with more severe liver disease and an infection in the past 6 months. Bacteria are isolated from approximately half of patients with a clinical diagnosis of infection. Gram-negative enterobacteriaceae are the most common organisms among community acquired infections; Gram-positive cocci are the most common organisms isolated among subjects with nosocomial infections. Up to 30 % of hospital associated infections are with multidrug resistant bacteria. Consequently, empiric antibiotic therapy that is recommended for community acquired infections is often inadequate for nosocomial infections. Infections worsen liver function. In-hospital and 1-year mortality of cirrhotics with infections is significantly higher than among cirrhotics without infection. In-hospital complications of infections, such as severe sepsis and septic shock, and mortality, are increased among subjects with multidrug-resistant infections as compared with cirrhotics with susceptible bacteria. Short-term antibiotic prophylaxis of cirrhotics with upper gastrointestinal bleeding and long-term antibiotic prophylaxis of selected cirrhotics with spontaneous bacterial peritonitis reduces infections and improves survival. Albumin administration to cirrhotics with SBP and evidence of advanced liver disease improves survival. The benefit of albumin administration to cirrhotics with infections other than SBP is under investigation.
Insights
Bacterial infections are common in hospitalized cirrhotics, increasing mortality. Antibiotic prophylaxis and albumin administration can improve survival in specific patient groups.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Bacterial infections affect 25-35% of hospitalized cirrhotics.
- Nosocomial infections are most common, with spontaneous bacterial peritonitis and urinary tract infections being frequent sites.
- Risk factors include severe liver disease and prior infections.
Purpose of the Study:
- To review the epidemiology, outcomes, and management of bacterial infections in cirrhosis.
- To highlight the challenges posed by multidrug-resistant organisms.
- To discuss the role of antibiotic prophylaxis and albumin therapy.
Main Methods:
- Literature review and synthesis of existing data on infections in cirrhosis.
- Analysis of common pathogens in community-acquired versus nosocomial infections.
- Evaluation of the impact of infections on liver function, mortality, and complications.
Main Results:
- Gram-negative bacteria are common in community-acquired infections, while Gram-positive bacteria dominate nosocomial infections.
- Up to 30% of hospital-acquired infections involve multidrug-resistant bacteria.
- Infections significantly increase in-hospital and 1-year mortality, with multidrug-resistant infections leading to worse outcomes.
Conclusions:
- Infections are a major cause of morbidity and mortality in cirrhosis.
- Antibiotic prophylaxis strategies, including short-term for gastrointestinal bleeding and long-term for spontaneous bacterial peritonitis, improve survival.
- Albumin administration shows survival benefits in spontaneous bacterial peritonitis and advanced liver disease.
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