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Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
Published on: November 27, 2019
Infections and Antimicrobial Management in Patients With Acute Liver Failure
Cremascoli Luca1, Puppo Mattia1, Martini Silvia2
1Unit of Anesthesia and Intensive Care, Città della Salute e della Scienza, Turin, Italy.
Journal of Intensive Care Medicine
|June 10, 2026
Summary
Acute liver failure (ALF) patients face high infection risks due to immune dysregulation. Early diagnosis and tailored antimicrobial strategies are crucial for survival and preventing multidrug-resistant (MDR) infections.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Acute liver failure (ALF) involves severe liver dysfunction and immune system dysregulation, leading to increased susceptibility to infections.
- In intensive care units (ICUs), bacterial sepsis and fungal infections significantly impact patient outcomes, including multiorgan failure and transplant eligibility.
- The immune response in ALF progresses from hyperinflammation to profound immunoparesis, increasing risks of bacterial translocation and multidrug-resistant (MDR) pathogen infections.
Purpose of the Study:
- To review current evidence on infectious risks, diagnostic difficulties, and antimicrobial treatment strategies in patients with ALF.
- To highlight the challenges in differentiating sterile inflammation from sepsis in ALF and the limitations of conventional biomarkers.
- To emphasize the importance of individualized antimicrobial therapy and perioperative management in liver transplant candidates and recipients.
Main Methods:
- This is a narrative review synthesizing existing research on infections in ALF.
- The review examines the immunological changes, diagnostic hurdles, and treatment approaches for infections in ALF patients.
- Evidence on antimicrobial management, considering pharmacokinetic alterations and MDR pathogen risks, is discussed.
Main Results:
- Infections are prevalent in ALF patients, but distinguishing sepsis from sterile inflammation is difficult due to nonspecific symptoms and negative cultures.
- Immune dysregulation in ALF, characterized by initial hyperinflammation followed by immunoparesis, contributes to infection susceptibility.
- Current biomarkers often reflect liver injury rather than active infection, complicating diagnosis.
Conclusions:
- Optimizing infection diagnosis and implementing biomarker-guided, individualized antimicrobial dosing are critical for improving ALF patient outcomes.
- Careful management of antimicrobial prophylaxis in liver transplant settings is essential to prevent infections and curb MDR pathogen emergence.
- Addressing diagnostic challenges and tailoring antimicrobial strategies are key to improving survival and reducing antimicrobial resistance in ALF.
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