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Semin Liver Dis 2022; 42(03): 293-312
DOI: 10.1055/a-1869-7607
Review Article


EARLY DIAGNOSIS AND PREVENTION OF INFECTIONS IN CIRRHOSIS

Anand V. Kulkarni 
1   Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad,
Telangana, India
,
Madhumita Premkumar 
2   Department of Hepatology, Postgraduate Institute of Medical Education and
Research, Chandigarh, India
,
Juan P. Arab 
3   Departamento de Gastroenterologia, Escuela de Medicina, Pontificia
Universidad Catolica de Chile, Santiago, Chile
,
Karan Kumar 
4   Department of Hepatology, Mahatma Gandhi Medical College and Hospital,
Jaipur, Rajasthan, India
,
Mithun Sharma
1   Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad,
Telangana, India
,
Nageshwar D. Reddy 
1   Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad,
Telangana, India
,
Nagaraja R. Padaki 
1   Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad,
Telangana, India
,
Rajender K. Reddy 
5   Division of Gastroenterology and Hepatology, University of Pennsylvania,
Philadelphia, Pennsylvania

› Institutsangaben Funding None.

› Weitere Informationen
 * Abstract
 * Volltext
 * Referenzen
 * Zusatzmaterial

 

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ABSTRACT

Strategies to prevent infection and improve outcomes in patients with cirrhosis.
HAV, hepatitis A virus; HBV, hepatitis B virus; COVID-19, novel coronavirus
disease 2019; NSBB, nonselective β-blocker; PPI, proton pump inhibitors.

Cirrhosis is a risk factor for infections. Majority of hospital admissions in
patients with cirrhosis are due to infections. Sepsis is an immunological
response to an infectious process that leads to end-organ dysfunction and death.
Preventing infections may avoid the downstream complications, and early
diagnosis of infections may improve the outcomes. In this review, we discuss the
pathogenesis, diagnosis, and biomarkers of infection; the incremental preventive
strategies for infections and sepsi; and the consequent organ failures in
cirrhosis. Strategies for primary prevention include reducing gut translocation
by selective intestinal decontamination, avoiding unnecessary proton pump
inhibitors' use, appropriate use of β-blockers, and vaccinations for viral
diseases including novel coronavirus disease 2019. Secondary prevention includes
early diagnosis and a timely and judicious use of antibiotics to prevent organ
dysfunction. Organ failure support constitutes tertiary intervention in
cirrhosis. In conclusion, infections in cirrhosis are potentially preventable
with appropriate care strategies to then enable improved outcomes.




KEYWORDS

liver failure - infections - antibiotics - morbidity


LAY SUMMARY

Infections in patients with cirrhosis significantly contribute to morbidity and
mortality. Infections in cirrhosis frequently lead to organ failures. Therefore,
preventing infections may improve the outcomes of patients with cirrhosis by
preventing downstream complications. In this article, we discussed several
measures, including antibiotic and nonantibiotic-based interventions, to prevent
infections in cirrhosis and improve outcomes.



ABBREVIATIONS

ACLF, acute-on-chronic liver failure; AKI, acute kidney injury; ARG, antibiotic
resistance gene; BI, bacterial infection; BT, bacterial translocation;
CLIF-SOFA, chronic liver failure-sequential organ failure assessment; CLP, cecal
ligation and puncture; COVID-19, novel coronavirus disease 2019; CRP, C-reactive
protein; FA, fatty acid; FMT, fecal microbiota transplantation; G-CSF,
granulocyte-colony stimulating factor; GNB, gram-negative bacilli; GPC,
gram-positive cocci; HAS, human albumin solution; HO-1, heme oxygenase-1; ICU,
intensive care unit; IFN, interferon; iNOS, endotoxin-induced nitric oxide
synthase; LPS, lipopolysaccharide; LTB4, leukotriene B4; MDRO, multi-drug
resistant organism; MR-proADM, mid-regional pro-adrenomedullin; NAFLD,
nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; NLR,
neutrophil-to-lymphocyte ratio; NSBB, Nonselective β-blocker; PCT,
procalcitonin; PG, prostaglandin; PGE2, prostaglandin E2; PPI, proton pump
inhibitor; qSOFA, quick sequential organ failure assessment; recAP, recombinant
alkaline phosphatase; SBP, spontaneous bacterial peritonitis; SID, selective
intestinal decontamination; SIRS, systemic inflammatory response syndrome; SOFA,
sequential organ failure assessment; SSTI, skin and soft tissue infection; UTI,
urinary tract infection; TLR, toll-like receptor; TNF, tumor necrosis factor;
TREM-1, triggering receptor expressed on myeloid cells-1; WCC, white cell count.



AUTHORS' CONTRIBUTIONS

K.R.R. and N.R.P. developed the study concept; A.V.K., K.K., and M.P. wrote the
initial draft; A.V.K. and M.P. prepared the figures; J.P.A., M.S., and K.K.
prepared the tables; J.P.A., D.N.R., N.R.P., and K.R.R. critically assessed the
draft. K.R.R. and A.V.K. are the guarantors of the article. All members approved
the final manuscript.



SUPPLEMENTARY MATERIAL

 * Supplementary Material




PUBLIKATIONSVERLAUF

Accepted Manuscript online:
07. Juni 2022

Artikel online veröffentlicht:
10. August 2022


© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA


 
   


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