Evaluating the best empirical antibiotic therapy in patients with acute-on-chronic liver failure and spontaneous bacterial peritonitis

2019 ◽  
Vol 51 (9) ◽  
pp. 1300-1307 ◽  
Author(s):  
Andreas Wieser ◽  
Hanwei Li ◽  
Jiang Zhang ◽  
Ingrid Liss ◽  
Daniel Markwardt ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Liver Failure ◽  
Spontaneous Bacterial Peritonitis ◽  
Chronic Liver ◽  
Empirical Antibiotic Therapy ◽  
Chronic Liver Failure ◽  
Bacterial Peritonitis

scholarly journals Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis

Gut ◽  
2017 ◽  
Vol 67 (10) ◽  
pp. 1870-1880 ◽  
Author(s):  
Javier Fernández ◽  
Juan Acevedo ◽  
Reiner Wiest ◽  
Thierry Gustot ◽  
Alex Amoros ◽  
...  
Keyword(s):  
Liver Failure ◽  
Systemic Inflammation ◽  
Bacterial Infections ◽  
Clinical Course ◽  
Fungal Infections ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Bacterial Peritonitis ◽  
Probability Of Survival

Bacterial infection is a frequent trigger of acute-on-chronic liver failure (ACLF), syndrome that could also increase the risk of infection. This investigation evaluated prevalence and characteristics of bacterial and fungal infections causing and complicating ACLF, predictors of follow-up bacterial infections and impact of bacterial infections on survival.Patients407 patients with ACLF and 235 patients with acute decompensation (AD).Results152 patients (37%) presented bacterial infections at ACLF diagnosis; 46%(n=117) of the remaining 255 patients with ACLF developed bacterial infections during follow-up (4 weeks). The corresponding figures in patients with AD were 25% and 18% (p<0.001). Severe infections (spontaneous bacterial peritonitis, pneumonia, severe sepsis/shock, nosocomial infections and infections caused by multiresistant organisms) were more prevalent in patients with ACLF. Patients with ACLF and bacterial infections (either at diagnosis or during follow-up) showed higher grade of systemic inflammation at diagnosis of the syndrome, worse clinical course (ACLF 2-3 at final assessment: 47% vs 26%; p<0.001) and lower 90-day probability of survival (49% vs 72.5%;p<0.001) than patients with ACLF without infection. Bacterial infections were independently associated with mortality in patients with ACLF-1 and ACLF-2. Fungal infections developed in 9 patients with ACLF (2%) and in none with AD, occurred mainly after ACLF diagnosis (78%) and had high 90-day mortality (71%).ConclusionBacterial infections are extremely frequent in ACLF. They are severe and associated with intense systemic inflammation, poor clinical course and high mortality. Patients with ACLF are highly predisposed to develop bacterial infections within a short follow-up period and could benefit from prophylactic strategies.

scholarly journals Macrophages in Chronic Liver Failure: Diversity, Plasticity and Therapeutic Targeting

2021 ◽  
Vol 12 ◽  
Author(s):  
Arjuna Singanayagam ◽  
Evangelos Triantafyllou
Keyword(s):  
Liver Failure ◽  
Bacterial Infections ◽  
Cell Activation ◽  
Immune Cell ◽  
Cell Damage ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Bacterial Peritonitis ◽  
Disease States ◽  
Macrophage Populations

Chronic liver injury results in immune-driven progressive fibrosis, with risk of cirrhosis development and impact on morbidity and mortality. Persistent liver cell damage and death causes immune cell activation and inflammation. Patients with advanced cirrhosis additionally experience pathological bacterial translocation, exposure to microbial products and chronic engagement of the immune system. Bacterial infections have a high incidence in cirrhosis, with spontaneous bacterial peritonitis being the most common, while the subsequent systemic inflammation, organ failure and immune dysregulation increase the mortality risk. Tissue-resident and recruited macrophages play a central part in the development of inflammation and fibrosis progression. In the liver, adipose tissue, peritoneum and intestines, diverse macrophage populations exhibit great phenotypic and functional plasticity determined by their ontogeny, epigenetic programming and local microenvironment. These changes can, at different times, promote or ameliorate disease states and therefore represent potential targets for macrophage-directed therapies. In this review, we discuss the evidence for macrophage phenotypic and functional alterations in tissue compartments during the development and progression of chronic liver failure in different aetiologies and highlight the potential of macrophage modulation as a therapeutic strategy for liver disease.

Bacterial Infections in Acute-on-Chronic Liver Failure

2018 ◽  
Vol 38 (02) ◽  
pp. 121-133 ◽  
Author(s):  
Lingling Yang ◽  
Tianzhou Wu ◽  
Jiang Li ◽  
Jun Li
Keyword(s):  
Liver Failure ◽  
Bacterial Infections ◽  
Management Strategies ◽  
Clinical Syndrome ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Bacterial Peritonitis ◽  
Specific Complication ◽  
Short Term Mortality ◽  
Tract Infections

AbstractAcute-on-chronic liver failure (ACLF) is a newly recognized clinical syndrome characterized by preexisting chronic liver disease or cirrhosis with organ failure and high 28-day mortality (50–90%). Bacterial infections (BIs) play pivotal roles in the development and progression of ACLF either as a main precipitating event or a specific complication. The main organisms isolated as triggering ACLF are Gram-positive bacteria, followed by Gram-negative bacteria. Spontaneous bacterial peritonitis, pneumonia, urinary tract infections, and skin infections are prevalent infections that trigger and complicate ACLF. Despite appropriate antibiotic treatment, BIs account for poor ACLF outcomes and lead to a worse clinical course and higher intensive care unit admission and short-term mortality. Early diagnosis and novel nonantibiotic methods are highly important for managing BIs. Thus, this review focuses on the epidemiology, prognosis, and diagnosis of and management strategies for BIs in ACLF patients as well as the relationship between BIs and ACLF.

Management of Cirrhosis and Associated Complications

2009 ◽  
Vol 22 (3) ◽  
pp. 290-309
Author(s):  
Robert MacLaren
Keyword(s):  
Portal Hypertension ◽  
Liver Failure ◽  
Spontaneous Bacterial Peritonitis ◽  
Hepatorenal Syndrome ◽  
Hepatopulmonary Syndrome ◽  
Chronic Liver Failure ◽  
Bacterial Peritonitis ◽  
Injured Tissue ◽  
Organ Systems ◽  
End Stage

Liver cirrhosis is the encapsulation or replacement of injured tissue by collagen, resulting in end-stage liver disease and portal hypertension. The consequences of cirrhosis are impaired hepatocyte function, increase intrahepatic circulatory resistance, portal hypertension, and the development of hepatocellular carcinoma. Complications include encephalopathy, coagulopathy, varices, ascites, spontaneous bacterial peritonitis, epatorenal syndrome, and hepatopulmonary syndrome. Managing patients with acute or chronic liver failure is challenging, and liver failure may have profound effects on other organ systems. Most therapies are directed at managing the complications and bridging patients to liver transplantation. The clinician must be aware of the pathologic presentations and the appropriate management, including pharmacologic and nonpharmacologic therapies, goals and end points of therapy, and monitoring of therapy. This review focuses on the management of the complications directly associated with liver dysfunction (encephalopathy and coagulopathy) and portal hypertension (varices, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatopulmonary syndrome).

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