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Infections in Cirrhosis

Sirina Ekpanyapong¹, K Rajender Reddy²

¹Division of Gastroenterology and Hepatology, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, HUP, Philadelphia, PA, 19104, USA.

Current Treatment Options in Gastroenterology

|April 14, 2019

Abstract

Purpose Of Review:

Patients with cirrhosis are at high risk of developing serious infections. Bacterial infections remain the most common cause of morbidity and mortality in these patients. This review is focused on the prevalence of infections in those with cirrhosis, including multidrug-resistant (MDR) pathogens, pathogenesis of infection-related acute-on-chronic liver failure (ACLF), current treatment recommendations, and prophylactic strategies in patients with cirrhosis.

Recent Findings:

Recent epidemiological studies have noted an emerging prevalence of MDR bacterial infections and associated with poor prognosis, and a high rate of treatment failure and mortality. Therefore, new recommendations on empirical antibiotic use based on epidemiological data have been developed in order to improve outcomes. Spontaneous bacterial peritonitis (SBP) and urinary tract infection (UTI) are the most frequent infections followed by pneumonia, cellulitis, and bacteremia, while pneumonia carries the highest risk of mortality. The incidence of MDR bacterial infections has been increasing, especially in healthcare-associated settings. Second infections that develop during hospitalization, multiple organ failures, and high MELD score are associated with poor survival. Preventive measures, early diagnosis, and adequate treatment of infections are essential key concepts in minimizing morbidity and mortality in patients with cirrhosis.

Insights

Patients with cirrhosis face high risks of bacterial infections, including multidrug-resistant (MDR) strains. Early diagnosis and treatment are crucial for preventing severe outcomes like acute-on-chronic liver failure (ACLF).

Area of Science:

Hepatology
Infectious Diseases
Microbiology

Background:

Cirrhosis patients have a high susceptibility to bacterial infections, a leading cause of mortality.
Infections significantly contribute to morbidity and mortality in individuals with liver cirrhosis.

Purpose of the Study:

To review the prevalence of infections in cirrhosis patients, focusing on multidrug-resistant (MDR) pathogens.
To discuss the pathogenesis of infection-related acute-on-chronic liver failure (ACLF).
To outline current treatment and prophylactic strategies for infections in cirrhosis.

Main Methods:

Literature review of recent epidemiological studies on infections in cirrhosis.
Analysis of data on prevalence, risk factors, and outcomes of bacterial infections.
Synthesis of current treatment guidelines and preventive measures.

Main Results:

Emerging prevalence of MDR bacterial infections in cirrhosis patients, linked to poor prognosis.
Spontaneous bacterial peritonitis (SBP) and urinary tract infections (UTI) are most common; pneumonia has the highest mortality risk.
Increasing incidence of MDR infections in healthcare settings; factors like hospitalization, organ failure, and high MELD scores correlate with poor survival.

Conclusions:

Prompt diagnosis and effective treatment of infections are vital for reducing mortality in cirrhosis.
Updated empirical antibiotic strategies based on local epidemiology are recommended.
Preventive measures are essential to mitigate the impact of infections in this vulnerable population.

Read full analysis

Keywords:

Acute-on-chronic liver failure Bacterial translocation Cirrhosis Multidrug-resistant Spontaneous bacterial peritonitis Vaccination

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