Bacterial infections in cirrhosis: A critical review and practical guidance

作     者：Chalermrat Bunchorntavakul Naichaya Chamroonkul Disaya Chavalitdhamrong 

作者机构：Division of Gastroenterology and Hepatology Department of Internal Medicine Rajavithi Hospital College of Medicine Rangsit University Division of Gastroenterology and Hepa-tology Department of Internal Medicine Faculty of Medicine Prince of Songkla University Division of GastroenterologyDepartment of Internal Medicine Harbor--UCLA Medical 

出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)

年 卷 期：2016年第8卷第6期

页      面：307-321页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Bacteria Infection Sepsis Bacteremia Liver cirrhosis Vaccination Spontaneous peritonitis Immune dysfunction 

摘      要：Bacterial infection is common and accounts for major morbidity and mortality in cirrhosis. Patients with cirrhosis are immunocompromised and increased susceptibility to develop spontaneous bacterial infections, hospital-acquired infections, and a variety of infections from uncommon pathogens. Once infection develops, the excessive response of pro-inflammatory cytokines on a pre-existing hemodynamic dysfunction in cirrhosis further predispose the development of serious complications such as shock, acute-on-chronic liver failure, renal failure, and death. Spontaneous bacterial peritonitis and bacteremia are common in patients with advanced cirrhosis, and are important prognostic landmarks in the natural history of cirrhosis. Notably, the incidence of infections from resistant bacteria has increased significantly in healthcare-associated settings. Serum biomarkers such as procalcitonin may help to improve the diagnosis of bacterial infection. Preventive measures(e.g., avoidance, antibiotic prophylaxis, and vaccination), early recognition, and proper management are required in order to minimize morbidity and mortality of infections in cirrhosis.