engleski

Infections related morbidity and mortality in the cirrhosis of the liver

Bacterial infection is a common complication of liver cirrhosis and accounts for major morbidity and mortality. Cirrhosis associated immune dysfunction and bacterial translocation are the key pathophysiologic mechanisms favoring this increased susceptibility. The most common types of bacterial infections in liver cirrhosis are spontaneous bacterial peritonitis (SBP), urinary tract infection and pneumonia. Usually these infections are caused by gram negative bacteria. However, in clinical settings, gram positive microbes predominate and more than half of them are multi drug resistant. Due to the altered immune response commonly encountered in liver cirrhosis, presentation of the disease might be atypical. Because of this, diagnosis is often difficult and clinical suspicion should be kept high. The presence of SIRS, increased CRP and procalcitonin are current markers used to facilitate diagnosis and microbiological culture methods are the standard to identify causative agents. Current research is working on newer technologies, that can identify pathogens earlier and hence allow early targeted therapy. Once infection in patients with cirrhosis is suspected, it is crucial to initiate antibiotic treatment immediately, since a delay is associated with increased incidence of complications and death. Antibiotics should be chosen according to type, severity and origin of infection and one should be familiar with the local epidemiological patterns of antibiotic resistance. Prophylactic antibiotic treatment has proven to be efficient, but must be strictly reserved for patients, who are at risk for bacterial infections, in order to prevent emergence of antibiotic resistance. Belonging to this category are patients with upper gastrointestinal bleeding, advanced cirrhosis and previous history of SPB. Despite improvements in prophylaxis and treatment, unfortunately prognosis of infections in liver cirrhosis remains poor. Out of the infected cirrhotic patients approximately 29% die within the first month, 44% within the first three months and 63% within the first year.

cirrhosis ; bacterial infection ; immune dysfunction ; antibiotic treatment ; mortality

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