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seminars in liver disease * EN * DE * Home * Produkte * Zeitschriften * Bücher * Buchreihen * Service * Service für Bibliotheken * Hilfe * Kontakt * Portal Seminars in Liver Disease Volltextsuche * Volltextsuche * Autorensuche * Titelsuche * DOI-Suche * Metadatensuche * * * * * * Zeitschrift * Aims and Scope * Herausgeber * Informationen zur DFG-Nationallizenz * Autoren * Autorenhinweise * Manuskripteinreichung * Abonnement * Ihr Abonnement: Kontakt & Information * Lizenzen: Kontaktpartner Institutionen * nicht eingeloggt Login * Benutzername: Passwort: Passwort vergessen? Benutzername vergessen? Neu registrieren OpenAthens/Shibboleth Login * Warenkorb Jahre (Archiv) 2022 * 2022 * 2021 * 2020 * 2019 * 2018 * 2017 * 2016 * 2015 * 2014 * 2013 * 2012 * 2011 * 2010 * 2009 * 2008 * 2007 * 2006 * 2005 * 2004 * 2003 * 2002 * 2001 * 2000 * 1999 * 1998 * 1997 * 1996 * 1995 * 1994 * 1993 * 1992 * 1991 * 1990 * 1989 * 1988 * 1987 * 1986 * 1985 * 1984 * 1983 * 1982 * 1981 Ausgaben * 03: 233-412 * 02: 113-232 * 01: 1-111 | e1 * Inhaltsverzeichnis * Aktuelle Ausgabe * Kostenlose Probeausgabe (01/2022) Ähnliche Zeitschriften * Endoscopy * Endoscopy International Open * Clinics in Colon and Rectal Surgery * Digestive Disease Interventions * Journal of Coloproctology * Journal of Digestive Endoscopy * Journal of Gastrointestinal and Abdominal Radiology Bücher zum Thema * Gastroenterologie RSS-FEED ABONNIEREN Bitte kopieren Sie die angezeigte URL und fügen sie dann in Ihren RSS-Reader ein. https://www.thieme-connect.de/rss/thieme/de/10.1055-s-00000069.xml TEILEN / BOOKMARKEN Facebook Twitter Linkedin Weibo PDF herunterladen 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 Lizenzen und Reprints 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 * REFERENCES * 1 Foreman MG, Mannino DM, Moss M. Cirrhosis as a risk factor for sepsis and death: analysis of the National Hospital Discharge Survey. Chest 2003; 124 (03) 1016-1020 * 2 Navasa M, Fernández J, Rodés J. Bacterial infections in liver cirrhosis. Ital J Gastroenterol Hepatol 1999; 31 (07) 616-625 * 3 Levesque E, Saliba F, Ichaï P, Samuel D. Outcome of patients with cirrhosis requiring mechanical ventilation in ICU. J Hepatol 2014; 60 (03) 570-578 * 4 Piano S, Singh V, Caraceni P. et al; International Club of Ascites Global Study Group. Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide. Gastroenterology 2019; 156 (05) 1368-1380 .e10 * 5 Singer M, Deutschman CS, Seymour CW. et al. The third international consensus definitions for sepsis and septic shock (SEPSIS-3). JAMA 2016; 315 (08) 801-810 * 6 Hensley MK, Deng JC. Acute on chronic liver failure and immune dysfunction: a mimic of sepsis. Semin Respir Crit Care Med 2018; 39 (05) 588-597 * 7 Arabi YM, Dara SI, Memish Z. et al; Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group. Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis. 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