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Hepatology International

, Volume 8, Supplement 2, pp 467–474 | Cite as

Bacterial infections in cirrhosis

  • Gregory J. Botwin
  • Timothy R. MorganEmail author
Supplement Issue: ALPD

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.

Keywords

Infection Cirrhosis Antibiotics Multidrug-resistant bacteria Survival Sepsis 

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

Notes

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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Copyright information

© Asian Pacific Association for the Study of the Liver 2014

Authors and Affiliations

  1. 1.Gastroenterology Services, VA Long Beach Healthcare Group-11 (GI)VA Long Beach Healthcare SystemLong BeachUSA
  2. 2.Gastroenterology Section, Department of MedicineUniversity of CaliforniaIrvineUSA

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