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Bacterial infections in cirrhosis

  • Supplement Issue: ALPD
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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.

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Abbreviations

ACLF:

Acute on chronic liver failure

CA:

Community acquired

DF:

Discriminant function

ESBL:

Extended-spectrum β-lactamase

GNB:

Gram-negative bacteria

GPC:

Gram-positive cocci

HA:

Hospital acquired

HCA:

Healthcare associated

HR:

Hazard ratio

MDR:

Multidrug-resistant

OR:

Odds ratio

SBP:

Spontaneous bacterial peritonitis

UTI:

Urinary tract infection

VRE:

Vancomycin-resistant enterococci

WBC:

White blood cell count

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Compliance with ethical requirements and Conflict of interest

This article does not contain studies with human or animal subjects performed by any of the authors. Gregory J. Botwin and Timothy R. Morgan declare that they have no conflict of interest.

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Authors and Affiliations

  1. Gastroenterology Services, VA Long Beach Healthcare Group-11 (GI), VA Long Beach Healthcare System, 5901 E. Seventh Street, Long Beach, CA, 90822, USA

    Gregory J. Botwin & Timothy R. Morgan

  2. Gastroenterology Section, Department of Medicine, University of California, Irvine, CA, USA

    Gregory J. Botwin & Timothy R. Morgan

Authors
  1. Gregory J. Botwin
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  2. Timothy R. Morgan
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Correspondence to Timothy R. Morgan.

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Botwin, G.J., Morgan, T.R. Bacterial infections in cirrhosis. Hepatol Int 8 (Suppl 2), 467–474 (2014). https://doi.org/10.1007/s12072-014-9522-z

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  • DOI: https://doi.org/10.1007/s12072-014-9522-z

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