The influence of bacterial infections on the course and outcome of patients with liver cirrhosis: Prophylaxis and treatment

Abstract

Bacterial infections in liver cirrhosis are very common and currently represent one of the most important causes of progression of liver disease, repeated hospitalizations and leading cause of death. The incidence of bacterial infections is 4-5 times higher in patients with cirrhosis compared to the general population, while mortality is 3.75 times higher in patients who develop bacterial infection. Spontaneous bacterial peritonitis, urinary infection, pneumonia, skin and soft tissue infections, and bacteremia are the most common bacterial infections, and E. coli, Klebsiella pneumoniae and Enterobacteriaceae are among the most common causes of these. In recent years, research has shown that increasingly frequent bacterial infections are present in patients with cirrhosis of multi-drug resistant bacteria (MDRs) such as Enterobacteriaceae extended spectrum that produce b-lactamase (ESBL), non-fermentable gram negative bacilli such as Pseudomonas aeruginosa , Stenotrophomonas maltophilia, Acinetobacter baumanii, Meticillin-resistant Staphylococcus aureus (MRSA), Vancomycin-sensitive or resistant Enterococci (VSE, VRE). Recent studies have shown that there is an increasing prevalence of resistance to the most frequently used antibiotics in patients with cirrhosis of the liver, such as Norfloxacin and the third generation Cephalosporin, and therefore an early antibiotic treatment with adequate antibiotics is of crucial importance.