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Spontaneous bacterial peritonitis: The clinical challenge of a leaky gut and a cirrhotic liver

World Journal of Hepatology 2015年第3期7卷 304-314页

作者： Philipp Lutz Hans Dieter Nischalke Christian P Strassburg Ulrich Spengler Department of Internal Medicine I University of Bonn German Center for Infection Research

Spontaneous bacterial peritonitis(SBP) is a frequent, life-threatening bacterial infection in patients with liver cirrhosis and ascites. Portal hypertension leads to increased bacterial translocation from the intestine. Failure to eliminate invading pathogens due to immune defects associated with advanced liver disease on the background of genetic predisposition may result in SBP. The efficacy of antibiotic treatment and prophylaxis has declined due to the spread of multi-resistant bacteria. Patients with nosocomial SBP and with prior antibiotictreatment are at a particularly high risk for infection with resistant bacteria. Therefore, it is important to adapt empirical treatment to these risk factors and to the local resistance profile. Rifaximin, an oral, nonabsorbable antibiotic, has been proposed to prevent SBP, but may be useful only in a subset of patients. Since novel antibiotic classes are lacking, we have to develop prophylactic strategies which do not induce bacterial resistance. Farnesoid X receptor agonists may be a candidate, but so far, clinical studies are not available. New diagnostic tests which can be carried out quickly at the patient's site and provide additional prognostic information would be helpful. Furthermore, we need tools to predict antibiotic resistance in order to tailor first-line antibiotic treatment of spontaneous bacterial peritonitis to the individual patient and to reduce mortality.

关键词： Ascites Cirrhosis Farnesoid X receptor Liver Nucleotide-binding oligomerization domaincontaining 2 Rifaximin Prophylaxis spontaneousbacterial peritonitis Toll-like receptor 2

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