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Bacterial and fungal infection in acute liver failure
N Rolando1, J Philpott-Howard, R Williams
1Institute of Liver Studies, King's College Hospital, London, United Kingdom.
Abstract:
Patients with acute liver failure (ALF) have increased susceptibility to infections, principally as a result of impaired phagocytic function, reduced complement levels, and the need for invasive procedures. Bacteriologically proven infection is recorded in up to 80% of these patients and fungal infection (predominantly candidiasis) in 32%. Clinical signs such as high temperature and high WBC are absent in 30% of the cases. Pneumonia accounts for 50% of infective episodes, and bacteremia and urinary tract infection a further 20 to 25% each, at a median 5, 3, and 2 days, respectively, after the onset of ALF. Selective parenteral and enteral antisepsis regimens (SPEAR) were evaluated in prospective controlled studies, but early systemic antibiotics alone are as effective as SPEAR. With early antibiotics, the incidence of infective episodes is reduced to 20% and the overall mortality to 44%, with a reduction in progression to encephalopathy and an increased opportunity for transplantation.
Insights
Patients with acute liver failure (ALF) are prone to infections due to impaired immunity. Early systemic antibiotics effectively reduce infection rates and mortality, improving transplant opportunities.
Area of Science:
- Infectious Diseases
- Hepatology
- Critical Care Medicine
Background:
- Patients with acute liver failure (ALF) exhibit heightened susceptibility to infections.
- Impaired immune function (phagocytosis, complement levels) and invasive procedures contribute to infection risk.
- Infections are prevalent, with up to 80% experiencing bacterial infections and 32% fungal infections (candidiasis).
Purpose of the Study:
- To evaluate the efficacy of selective parenteral and enteral antisepsis regimens (SPEAR) in preventing infections in ALF patients.
- To compare the effectiveness of SPEAR with early systemic antibiotic administration.
- To assess the impact of infection prevention strategies on patient outcomes, including mortality and encephalopathy progression.
Main Methods:
- Prospective controlled studies were conducted to assess infection prevention strategies.
- The study compared outcomes between patients receiving SPEAR and those treated with early systemic antibiotics alone.
- Data collection included infection incidence, types of infections, mortality rates, and progression of encephalopathy.
Main Results:
- Early systemic antibiotics demonstrated comparable effectiveness to SPEAR in reducing infection incidence.
- The incidence of infective episodes decreased to 20% with early antibiotic use.
- Overall mortality was reduced to 44%, with observed benefits in decreased encephalopathy progression and increased transplantation opportunities.
Conclusions:
- Early systemic antibiotic administration is a highly effective strategy for managing and preventing infections in acute liver failure (ALF) patients.
- This approach significantly reduces infection rates, mortality, and the severity of hepatic encephalopathy.
- Early antibiotic treatment improves patient outcomes and enhances the potential for liver transplantation in ALF.