medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2014, Number 1

<< Back Next >>

Ann Hepatol 2014; 13 (1)

The impact of bacterial infections on survival of patients with decompensated cirrhosis

Strauss E

Language: English
References: 93
Page: 7-19
PDF size: 149.35 Kb.


ABSTRACT

Introduction. Bacterial infection in cirrhotic patients is a severe complication that requires early recognition and specific therapeutic care. Material and methods. In this review the various aspects of diagnosis and management of infections that may impact survival in cirrhosis are analyzed. Results. Active search for infections allows early detection and its treatment with suitable antibiotics has reduced mortality rates in spontaneous bacterial peritonitis, the main infection in patients with decompensated cirrhosis. Other common infections, such as bacteremia and septicemia or urinary tract, lung, skin and soft tissue infections must be thoroughly investigated so that antibiotic treatment can be started early. As intestinal bacterial translocation is one of the most important mechanisms for development of bacterial infections, selective intestinal decontamination is able to prevent these infections in populations at risk. After the first episode of spontaneous bacterial peritonitis, poorly absorbed oral antibiotics, such as quinolones, must be started and continued. Moreover, when there is upper gastrointestinal bleeding, infection prevention should be based on oral administration of quinolones or intravenous administration of cephalosporins, both for seven days, to avoid morbidity and early lethality. With the advent of resistance to commonly used antibiotics and recent reports of multiresistant bacteria, there is a need for stricter control when administering antibiotics to cirrhotic patients. Conclusion. Existing knowledge of therapy and prophylaxis for bacterial infections in cirrhotic patients, which undoubtedly improve survival, should be disseminated and applied in clinical practice for the benefit of the population at large.


REFERENCES

  1. Hytiroglou P, Snover DC, Alves V, Balabaud C, Bhathal PS, Bioulac-Sage P, Crawford JM, et al. Beyond “cirrhosis”: a proposal from the International Liver Pathology Study Group. Am J Clin Pathol 2011; 137: 5-9.

  2. Pinzani M. Exploring beyond cirrhosis. Hepatology 2012; 56: 778-80.

  3. Albilllos A, Garcia-Tsao G. Classification of cirrhosis: the clinical use of HVPG measurements. Dis Markers 2011; 31: 121-8.

  4. D’Amico G. Natural History of Cirrhosis. In: AASLD (ed.). Cirrhosis: current challenges and futures directions. San Francisco, California: AASLD; 2011, p. 26-9.

  5. Wiest R, Garcia-Tsao G. Bacterial translocation (BT) in cirrhosis. Hepatology 2005; 41: 422-33.

  6. Arvaniti V, D’Amico G, Fede G, Manousou P, Tsochatzis E, Pleguezuelo M, Burroughs AK. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology 2010; 139: 1246-56, 1256 e1241-1245.

  7. Strauss E. Bacterial infections associated with hepatic encephalopathy: prevalence and outcome. Ann Hepatol 2003; 2: 41-5.

  8. Navasa M, Fernandez J, Rodes J. Bacterial infections in liver cirrhosis. Ital J Gastroenterol Hepatol 1999; 31: 616-25.

  9. Caly WR, Strauss E. A prospective study of bacterial infections in patients with cirrhosis. J Hepatol 1993; 18: 353-8.

  10. Fernandez J, Gustot T. Management of bacterial infections in cirrhosis. J Hepatol 2012; 56(Suppl.): S1-S12.

  11. Bittencourt PL, Farias AQ, Strauss E, Mattos AA. Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology. Arq Gastroenterol 2010; 47: 202-16.

  12. Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, Durand F, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144: 1426-37.

  13. Fernandez J, Navasa M, Gomez J, Colmenero J, Vila J, Arroyo V, Rodes J. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002; 35: 140-8.

  14. Garcia-Tsao G. Bacterial infections in cirrhosis: treatment and prophylaxis. J Hepatol 2005; 42(Suppl.): S85-92.

  15. Strauss E, Caly WR. Spontaneous bacterial peritonitis: a therapeutic update. Expert Rev Anti Infect Ther 2006; 4: 249-60.

  16. Bajaj JS, O’Leary JG, Reddy KR, Wong F, Olson JC, Subramanian RM, Brown G, et al. Second infections independently increase mortality in hospitalized patients with cirrhosis: the North American consortium for the study of end-stage liver disease (NACSELD) experience. Hepatology 2012; 56: 2328-35.

  17. Rimola A, Soto R, Bory F, Arroyo V, Piera C, Rodes J. Reticuloendothelial system phagocytic activity in cirrhosis and its relation to bacterial infections and prognosis. Hepatology 1984; 4: 53-8.

  18. Rajkovic IA, Williams R. Abnormalities of neutrophil phagocytosis, intracellular killing and metabolic activity in alcoholic cirrhosis and hepatitis. Hepatology 1986; 6: 252-62.

  19. Steed H, Macfarlane GT, Blackett KL, Macfarlane S, Miller MH, Bahrami B, Dillon JF. Bacterial translocation in cirrhosis is not caused by an abnormal small bowel gut microbiota. FEMS Immunol Med Microbiol 2011; 63: 346-54.

  20. Bellot P, Frances R, Such J. Pathological bacterial translocation in cirrhosis: pathophysiology, diagnosis and clinical implications. Liver Int 2012; 33: 31-9.

  21. Du Plessis J, Vanheel H, Janssen CE, Roos L, Slavik T, Stivaktas PI, Nieuwoudt M, et al. Activated intestinal macrophages in patients with cirrhosis release NO and IL-6 that may disrupt intestinal barrier function. J Hepatol 2013; 58: 1125-32.

  22. Appenrodt B, Grunhage F, Gentemann MG, Thyssen L, Sauerbruch T, Lammert F. Nucleotide-binding oligomerization domain containing 2 (NOD2) variants are genetic risk factors for death and spontaneous bacterial peritonitis in liver cirrhosis. Hepatology 2012; 51: 1327-33.

  23. Bruns T, Peter J, Reuken PA, Grabe DH, Schuldes SR, Brenmoehl J, Scholmerich J, et al. NOD2 gene variants are a risk factor for culture-positive spontaneous bacterial peritonitis and monomicrobial bacterascites in cirrhosis. Liver Int 2011; 32: 223-30.

  24. Bernardi M. Spontaneous bacterial peritonitis: from pathophysiology to prevention. Intern Emerg Med 2013; 5(Suppl. 1): S37-44.

  25. Trikudanathan G, Israel J, Cappa J, O’Sullivan DM. Association between proton pump inhibitors and spontaneous bacterial peritonitis in cirrhotic patients - a systematic review and meta-analysis. Int J Clin Pract 2011; 65: 674-8.

  26. Tito L, Rimola A, Gines P, Llach J, Arroyo V, Rodes J. Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors. Hepatology 1988; 8: 27-31.

  27. Garcia-Tsao G. Spontaneous bacterial peritonitis: a historical perspective. J Hepatol 2004; 41: 522-27.

  28. Runyon BA. Spontaneous bacterial peritonitis: an explosion of information. Hepatology 1988; 8: 171-5.

  29. Stassen WN, McCullough AJ, Bacon BR, Gutnik SH, Wadiwala IM, McLaren C, Kalhan SC, et al. Immediate diagnostic criteria for bacterial infection of ascitic fluid. Evaluation of ascitic fluid polymorphonuclear leukocyte count, pH, and lactate concentration, alone and in combination. Gastroenterology 1986; 90: 1247-54.

  30. Viallon A, Zeni F, Pouzet V, Lambert C, Quenet S, Aubert G, Guyomarch S, et al. Serum and ascitic procalcitonin levels in cirrhotic patients with spontaneous bacterial peritonitis: diagnostic value and relationship to pro-inflammatory cytokines. Intensive Care Med 2000; 26: 1082-8.

  31. Barreales M, Fernandez I. Spontaneous bacterial peritonitis. Rev Esp Enferm Dig 2011; 103: 255-63.

  32. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340: 448-54.

  33. Papp M, Vitalis Z, Altorjay I, Tornai I, Udvardy M, Harsfalvi J, Vida A, et al. Acute phase proteins in the diagnosis and prediction of cirrhosis associated bacterial infections. Liver Int 2011; 32: 603-11.

  34. Cervoni JP, Thevenot T, Weil D, Muel E, Barbot O, Sheppard F, Monnet E, et al. C-reactive protein predicts short-term mortality in patients with cirrhosis. J Hepatol 2012; 56: 1299-304.

  35. Koulaouzidis A, Leontiadis GI, Abdullah M, Moschos J, Gasem J, Tharakan J, Maltezos E, et al. Leucocyte esterase reagent strips for the diagnosis of spontaneous bacterial peritonitis: a systematic review. Eur J Gastroenterol Hepatol 2008; 20: 1055-60.

  36. Mendler MH, Agarwal A, Trimzi M, Madrigal E, Tsushima M, Joo E, Santiago M, et al. A new highly sensitive point of care screen for spontaneous bacterial peritonitis using the leukocyte esterase method. J Hepatol 2010; 53: 477- 83.

  37. Hardick J, Won H, Jeng K, Hsieh YH, Gaydos CA, Rothman RE, Yang S. Identification of bacterial pathogens in ascitic fluids from patients with suspected spontaneous bacterial peritonitis by use of broad-range PCR (16S PCR) coupled with high-resolution melt analysis. J Clin Microbiol 2012; 50: 2428-32.

  38. Bhattacharya S. Early diagnosis of resistant pathogens: how can it improve antimicrobial treatment? Virulence 2013; 4: 172-84.

  39. Runyon BA, Hoefs JC. Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. Hepatology 1984; 4: 1209-11.

  40. Runyon BA. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49: 2087- 107.

  41. EASL, Gines P, et al. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53: 397-417.

  42. Soriano G, Castellote J, Alvarez C, Girbau A, Gordillo J, Baliellas C, Casas M, et al. Secondary bacterial peritonitis in cirrhosis: a retrospective study of clinical and analytical characteristics, diagnosis and management. J Hepatol 2009; 52: 39-44.

  43. Runyon BA, Hoefs JC. Ascitic fluid analysis in the differentiation of spontaneous bacterial peritonitis from gastrointestinal tract perforation into ascitic fluid. Hepatology 1984; 4: 447-50.

  44. Akriviadis EA, Runyon BA. Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology 1990; 98: 127-33.

  45. Evans LT, Kim WR, Poterucha JJ, Kamath PS. Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites. Hepatology 2003; 37: 897-901.

  46. Felisart J, Rimola A, Arroyo V, Perez-Ayuso RM, Quintero E, Gines P, Rodes J. Cefotaxime is more effective than is ampicillin-tobramycin in cirrhotics with severe infections. Hepatology 1985; 5: 457-62.

  47. Rimola A, Salmeron JM, Clemente G, Rodrigo L, Obrador A, Miranda ML, Guarner C, et al. Two different dosages of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: results of a prospective, randomized, multicenter study. Hepatology 1995; 21: 674-79.

  48. Runyon BA, McHutchison JG, Antillon MR, Akriviadis EA, Montano AA. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. A randomized controlled study of 100 patients. Gastroenterology 1991; 100: 1737-42.

  49. Gomez-Jimenez J, Ribera E, Gasser I, Artaza MA, Del Valle O, Pahissa A, Martinez-Vazquez JM. Randomized trial comparing ceftriaxone with cefonicid for treatment of spontaneous bacterial peritonitis in cirrhotic patients. Antimicrob Agents Chemother 1993; 37: 1587-92.

  50. Terg R, Cobas S, Fassio E, Landeira G, Rios B, Vasen W, Abecasis R, et al. Oral ciprofloxacin after a short course of intravenous ciprofloxacin in the treatment of spontaneous bacterial peritonitis: results of a multicenter, randomized study. J Hepatol 2000; 33: 564-9.

  51. Navasa M, Follo A, Llovet JM, Clemente G, Vargas V, Rimola A, Marco F, et al. Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis. Gastroenterology 1996; 111: 1011-17.

  52. McCormick PA, Greenslade L, Kibbler CC, Chin JK, Burroughs AK, McIntyre N. A prospective randomized trial of ceftazidime versus netilmicin plus mezlocillin in the empirical therapy of presumed sepsis in cirrhotic patients. Hepatology 1997; 25: 833-6.

  53. Salerno F, Cazzaniga M. Therapeutic strategies and emergence of multiresistant bacterial strains. Intern Emerg Med 2010; 5(Suppl. 1): S45-51.

  54. Canton R, Coque TM, Baquero F. Multi-resistant Gram-negative bacilli: from epidemics to endemics. Curr Opin Infect Dis 2003; 16: 315-25.

  55. Fernandez J, Acevedo J, Castro M, Garcia O, de Lope CR, Roca D, Pavesi M, et al. Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study. Hepatology 2011; 55: 1551-61.

  56. Castellote J, Ariza X, Girbau A, Broquetas T, Lobatón T, Salord S, et al. Factores de riesgo para el desarrollo de una peritonitis bacteriana espontánea secundaria a un germe resistente a la cefotaximea. Gastroenterol Hepatol 2010; 33: 143.

  57. Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del- Arbol L, Castells L, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999; 341: 403-9.

  58. Sigal SH, Stanca CM, Fernandez J, Arroyo V, Navasa M. Restricted use of albumin for spontaneous bacterial peritonitis. Gut 2007; 56: 597-9.

  59. Guevara M, Terra C, Nazar A, Sola E, Fernandez J, Pavesi M, Arroyo V, et al. Albumin for bacterial infections other than spontaneous bacterial peritonitis in cirrhosis. A randomized, controlled study. J Hepatol 2012; 57: 759-65.

  60. Burroughs AK, Rosenstein IJ, Epstein O, Hamilton-Miller JM, Brumfitt W, Sherlock S. Bacteriuria and primary biliary cirrhosis. Gut 1984; 25: 133-7.

  61. Taneja SK, Dhiman RK. Prevention and management of bacterial infections in cirrhosis. Int J Hepatol 2011: 784540. Doi: 10.4061/2011/784540. Epub 2011 Aug 8.

  62. Hung TH, Tseng CW, Hsieh YH, Tseng KC, Tsai CC. High mortality of pneumonia in cirrhotic patients with ascites. BMC Gastroenterol 2013; 13: 13-25.

  63. Allam NA. Spontaneous bacterial empyema in liver cirrhosis: an underdiagnosed pleural complication. Saudi J Gastroenterol 2008; 14: 43-5.

  64. Pereira G, Guevara M, Fagundes C, Sola E, Rodriguez E, Fernandez J, Pavesi M, et al. Renal failure and hyponatremia in patients with cirrhosis and skin and soft tissue infection. A retrospective study. J Hepatol 2012; 56: 1040-6.

  65. Aroniadis OC, Brandt LJ. Fecal microbiota transplantation: past, present and future. Curr Opin Gastroenterol 2012; 29: 79-84.

  66. Kassam Z, Lee CH, Yuan Y, Hunt RH. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol 2013; 108: 500-8.

  67. Tandon P, Garcia-Tsao G. Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Semin Liver Dis 2008; 28: 26-42.

  68. Arabi Y, Ahmed QA, Haddad S, Aljumah A, Al-Shimemeri A. Outcome predictors of cirrhosis patients admitted to the intensive care unit. Eur J Gastroenterol Hepatol 2004; 16: 333-9.

  69. Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, Weiss YG, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med 2008; 358: 111-24.

  70. Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002; 288: 862-71.

  71. Arabi YM, Aljumah A, Dabbagh O, Tamim HM, Rishu AH, Al- Abdulkareem A, Knawy BA, et al. Low-dose hydrocortisone in patients with cirrhosis and septic shock: a randomized controlled trial. CMAJ 2010; 182: 1971-7.

  72. Gines P, Rimola A, Planas R, Vargas V, Marco F, Almela M, Forne M, et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double- blind, placebo-controlled trial. Hepatology 1990; 12: 716-24.

  73. Deschenes M, Villeneuve JP. Risk factors for the development of bacterial infections in hospitalized patients with cirrhosis. Am J Gastroenterol 1999; 94: 2193-7.

  74. Bernard B, Cadranel JF, Valla D, Escolano S, Jarlier V, Opolon P. Prognostic significance of bacterial infection in bleeding cirrhotic patients: a prospective study. Gastroenterology 1995; 108: 1828-34.

  75. Guarner C, Soriano G. Spontaneous bacterial peritonitis. Semin Liver Dis 1997; 17: 203-17.

  76. Bernard B, Grange JD, Khac EN, Amiot X, Opolon P, Poynard T. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology 1999; 29: 1655-61.

  77. Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L. Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding. Cochrane Database Syst Rev 2002: CD002907.

  78. Garcia-Tsao G, Bosch J, Groszmann RJ. Portal hypertension and variceal bleeding—unresolved issues. Summary of an American Association for the study of liver diseases and European Association for the study of the liver singletopic conference. Hepatology 2008; 47: 1764-72.

  79. Fernandez J, Ruiz del Arbol L, Gomez C, Durandez R, Serradilla R, Guarner C, Planas R, et al. Norfloxacin vs ceftriaxone in the prophylaxis of infections in patients with advanced cirrhosis and hemorrhage. Gastroenterology 2006; 131: 1049-56; quiz 1285.

  80. Younossi ZM, McHutchison JG, Ganiats TG. An economic analysis of norfloxacin prophylaxis against spontaneous bacterial peritonitis. J Hepatol 1997; 27: 295-8.

  81. Rimola A, Garcia-Tsao G, Navasa M, Piddock LJ, Planas R, Bernard B, Inadomi JM. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol 2000; 32: 142-53.

  82. Kalambokis GN, Mouzaki A, Rodi M, Tsianos EV. Rifaximin for the prevention of spontaneous bacterial peritonitis. World J Gastroenterol 2012; 18: 1700-2.

  83. Hanouneh MA, Hanouneh IA, Hashash JG, Law R, Esfeh JM, Lopez R, Hazratjee N, et al. The role of rifaximin in the primary prophylaxis of spontaneous bacterial peritonitis in patients with liver cirrhosis. J Clin Gastroenterol 2012: 709 -15.

  84. Llach J, Rimola A, Navasa M, Gines P, Salmeron JM, Gines A, Arroyo V, et al. Incidence and predictive factors of first episode of spontaneous bacterial peritonitis in cirrhosis with ascites: relevance of ascitic fluid protein concentration. Hepatology 1992; 16: 724-7.

  85. Fernandez J, Navasa M, Planas R, Montoliu S, Monfort D, Soriano G, Vila C, et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology 2007; 133: 818-24.

  86. Stadlbauer V, Mookerjee RP, Hodges S, Wright GA, Davies NA, Jalan R. Effect of probiotic treatment on deranged neutrophil function and cytokine responses in patients with compensated alcoholic cirrhosis. J Hepatol 2008; 48: 945-51.

  87. Lata J, Jurankova J, Kopacova M, Vitek P. Probiotics in hepatology. World J Gastroenterol 2011; 17: 2890-6.

  88. Pande C, Kumar A, Sarin SK. Addition of probiotics to norfloxacin does not improve efficacy in the prevention of spontaneous bacterial peritonitis: a double-blind placebocontrolled randomized-controlled trial. Eur J Gastroenterol Hepatol 2012; 24: 831-9.

  89. Senzolo M, Cholongitas E, Burra P, Leandro G, Thalheimer U, Patch D, Burroughs AK. Beta-Blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis. Liver Int 2009; 29: 1189-93.

  90. Sandhu BS, Gupta R, Sharma J, Singh J, Murthy NS, Sarin SK. Norfloxacin and cisapride combination decreases the incidence of spontaneous bacterial peritonitis in cirrhotic ascites. J Gastroenterol Hepatol 2005; 20: 599-605.

  91. Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila F, Soares-Weiser K, Mendez-Sanchez N, Gluud C, Uribe M. Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding - an updated Cochrane review. Aliment Pharmacol Ther 2011; 34: 509-18.

  92. Ortiz J, Vila MC, Soriano G, Minana J, Gana J, Mirelis B, Novella MT, et al. Infections caused by Escherichia coli resistant to norfloxacin in hospitalized cirrhotic patients. Hepatology 1999; 29: 1064-9.

  93. Piroth L, Pechinot A, Minello A, Jaulhac B, Patry I, Hadou T, Hansmann Y, et al. Bacterial epidemiology and antimicrobial resistance in ascitic fluid: a 2-year retrospective study. Scand J Infect Dis 2009; 41: 847-51.




2020     |     www.medigraphic.com