Bacterial infections in cirrhosis: A position statement based on the EASL Special Conference 2013

Rajiv Jalan; Javier Fernandez; Reiner Wiest; Bernd Schnabl; Richard Moreau; Paolo Angeli; Vanessa Stadlbauer; Thierry Gustot; Mauro Bernardi; Rafael Canton; Agustin Albillos; Frank Lammert; Alexander Wilmer; Rajeshwar Mookerjee; Jordi Vila; Rita Garcia-Martinez; Julia Wendon; Jose Such; Juan Cordoba; Arun Sanyal; Guadalupe Garcia-Tsao; Vicente Arroyo; Andrew Burroughs; Pere Gines

doi:10.1016/j.jhep.2014.01.024

Bacterial infections in cirrhosis: A position statement based on the EASL Special Conference 2013

Rajiv Jalan, Javier Fernandez, Reiner Wiest, Bernd Schnabl, Richard Moreau, Paolo Angeli, Vanessa Stadlbauer, Thierry Gustot, Mauro Bernardi, Rafael Canton, Agustin Albillos, Frank Lammert, Alexander Wilmer, Rajeshwar Mookerjee, Jordi Vila, Rita Garcia-Martinez, Julia Wendon, Jose Such, Juan Cordoba, Arun SanyalGuadalupe Garcia-Tsao, Vicente Arroyo, Andrew Burroughs, Pere Gines^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

711 Citations (Scopus)

Abstract

Bacterial infections are very common and represent one of the most important reasons of progression of liver failure, development of liver-related complications, and mortality in patients with cirrhosis. In fact, bacterial infections may be a triggering factor for the occurrence of gastrointestinal bleeding, hypervolemic hyponatremia, hepatic encephalopathy, kidney failure, and development of acute-on-chronic liver failure. Moreover, infections are a very common cause of repeated hospitalizations, impaired health-related quality of life, and increased healthcare costs in cirrhosis. Bacterial infections develop as a consequence of immune dysfunction that occurs progressively during the course of cirrhosis. In a significant proportion of patients, infections are caused by gram-negative bacteria from intestinal origin, yet gram-positive bacteria are a frequent cause of infection, particularly in hospitalized patients. In recent years, infections caused by multidrug-resistant bacteria are becoming an important clinical problem in many countries.

The reduction of the negative clinical impact of infections in patients with cirrhosis may be achieved by a combination of prophylactic measures, such as administration of antibiotics, to reduce the occurrence of infections in high-risk groups together with early identification and management of infection once it has developed. Investigation on the mechanisms of altered gut microflora, translocation of bacteria, and immune dysfunction may help develop more effective and safe methods of prevention compared to those that are currently available. Moreover, research on biomarkers of early infection may be useful in early diagnosis and treatment of infections.

The current manuscript reports an in-depth review and a position statement on bacterial infections in cirrhosis.

Original language	English
Pages (from-to)	1310-1324
Number of pages	15
Journal	Journal of Hepatology
Volume	60
Issue number	6
DOIs	https://doi.org/10.1016/j.jhep.2014.01.024
Publication status	Published - Jun 2014

Keywords

Cirrhosis
Bacterial infection
Multiresistant bacteria
Diagnosis
TUMOR-NECROSIS-FACTOR
CHRONIC LIVER-FAILURE
C-REACTIVE PROTEIN
ACUTE-PHASE PROTEINS
INCREASED INTESTINAL PERMEABILITY
SYSTEMIC INFLAMMATORY RESPONSE
CRITICALLY-ILL PATIENTS
MESENTERIC LYMPH-NODES
TNF-ALPHA PRODUCTION
ALCOHOLIC CIRRHOSIS

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10.1016/j.jhep.2014.01.024

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Jalan, R., Fernandez, J., Wiest, R., Schnabl, B., Moreau, R., Angeli, P., Stadlbauer, V., Gustot, T., Bernardi, M., Canton, R., Albillos, A., Lammert, F., Wilmer, A., Mookerjee, R., Vila, J., Garcia-Martinez, R., Wendon, J., Such, J., Cordoba, J., ... Gines, P. (2014). Bacterial infections in cirrhosis: A position statement based on the EASL Special Conference 2013. Journal of Hepatology, 60(6), 1310-1324. https://doi.org/10.1016/j.jhep.2014.01.024

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title = "Bacterial infections in cirrhosis: A position statement based on the EASL Special Conference 2013",

abstract = "Bacterial infections are very common and represent one of the most important reasons of progression of liver failure, development of liver-related complications, and mortality in patients with cirrhosis. In fact, bacterial infections may be a triggering factor for the occurrence of gastrointestinal bleeding, hypervolemic hyponatremia, hepatic encephalopathy, kidney failure, and development of acute-on-chronic liver failure. Moreover, infections are a very common cause of repeated hospitalizations, impaired health-related quality of life, and increased healthcare costs in cirrhosis. Bacterial infections develop as a consequence of immune dysfunction that occurs progressively during the course of cirrhosis. In a significant proportion of patients, infections are caused by gram-negative bacteria from intestinal origin, yet gram-positive bacteria are a frequent cause of infection, particularly in hospitalized patients. In recent years, infections caused by multidrug-resistant bacteria are becoming an important clinical problem in many countries. The reduction of the negative clinical impact of infections in patients with cirrhosis may be achieved by a combination of prophylactic measures, such as administration of antibiotics, to reduce the occurrence of infections in high-risk groups together with early identification and management of infection once it has developed. Investigation on the mechanisms of altered gut microflora, translocation of bacteria, and immune dysfunction may help develop more effective and safe methods of prevention compared to those that are currently available. Moreover, research on biomarkers of early infection may be useful in early diagnosis and treatment of infections. The current manuscript reports an in-depth review and a position statement on bacterial infections in cirrhosis.",

keywords = "Cirrhosis, Bacterial infection, Multiresistant bacteria, Diagnosis, TUMOR-NECROSIS-FACTOR, CHRONIC LIVER-FAILURE, C-REACTIVE PROTEIN, ACUTE-PHASE PROTEINS, INCREASED INTESTINAL PERMEABILITY, SYSTEMIC INFLAMMATORY RESPONSE, CRITICALLY-ILL PATIENTS, MESENTERIC LYMPH-NODES, TNF-ALPHA PRODUCTION, ALCOHOLIC CIRRHOSIS",

author = "Rajiv Jalan and Javier Fernandez and Reiner Wiest and Bernd Schnabl and Richard Moreau and Paolo Angeli and Vanessa Stadlbauer and Thierry Gustot and Mauro Bernardi and Rafael Canton and Agustin Albillos and Frank Lammert and Alexander Wilmer and Rajeshwar Mookerjee and Jordi Vila and Rita Garcia-Martinez and Julia Wendon and Jose Such and Juan Cordoba and Arun Sanyal and Guadalupe Garcia-Tsao and Vicente Arroyo and Andrew Burroughs and Pere Gines",

year = "2014",

month = jun,

doi = "10.1016/j.jhep.2014.01.024",

language = "English",

volume = "60",

pages = "1310--1324",

journal = "Journal of Hepatology",

issn = "0168-8278",

publisher = "Elsevier",

number = "6",

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Jalan, R, Fernandez, J, Wiest, R, Schnabl, B, Moreau, R, Angeli, P, Stadlbauer, V, Gustot, T, Bernardi, M, Canton, R, Albillos, A, Lammert, F, Wilmer, A, Mookerjee, R, Vila, J, Garcia-Martinez, R, Wendon, J, Such, J, Cordoba, J, Sanyal, A, Garcia-Tsao, G, Arroyo, V, Burroughs, A & Gines, P 2014, 'Bacterial infections in cirrhosis: A position statement based on the EASL Special Conference 2013', Journal of Hepatology, vol. 60, no. 6, pp. 1310-1324. https://doi.org/10.1016/j.jhep.2014.01.024

TY - JOUR

T1 - Bacterial infections in cirrhosis

T2 - A position statement based on the EASL Special Conference 2013

AU - Jalan, Rajiv

AU - Fernandez, Javier

AU - Wiest, Reiner

AU - Schnabl, Bernd

AU - Moreau, Richard

AU - Angeli, Paolo

AU - Stadlbauer, Vanessa

AU - Gustot, Thierry

AU - Bernardi, Mauro

AU - Canton, Rafael

AU - Albillos, Agustin

AU - Lammert, Frank

AU - Wilmer, Alexander

AU - Mookerjee, Rajeshwar

AU - Vila, Jordi

AU - Garcia-Martinez, Rita

AU - Wendon, Julia

AU - Such, Jose

AU - Cordoba, Juan

AU - Sanyal, Arun

AU - Garcia-Tsao, Guadalupe

AU - Arroyo, Vicente

AU - Burroughs, Andrew

AU - Gines, Pere

PY - 2014/6

Y1 - 2014/6

N2 - Bacterial infections are very common and represent one of the most important reasons of progression of liver failure, development of liver-related complications, and mortality in patients with cirrhosis. In fact, bacterial infections may be a triggering factor for the occurrence of gastrointestinal bleeding, hypervolemic hyponatremia, hepatic encephalopathy, kidney failure, and development of acute-on-chronic liver failure. Moreover, infections are a very common cause of repeated hospitalizations, impaired health-related quality of life, and increased healthcare costs in cirrhosis. Bacterial infections develop as a consequence of immune dysfunction that occurs progressively during the course of cirrhosis. In a significant proportion of patients, infections are caused by gram-negative bacteria from intestinal origin, yet gram-positive bacteria are a frequent cause of infection, particularly in hospitalized patients. In recent years, infections caused by multidrug-resistant bacteria are becoming an important clinical problem in many countries. The reduction of the negative clinical impact of infections in patients with cirrhosis may be achieved by a combination of prophylactic measures, such as administration of antibiotics, to reduce the occurrence of infections in high-risk groups together with early identification and management of infection once it has developed. Investigation on the mechanisms of altered gut microflora, translocation of bacteria, and immune dysfunction may help develop more effective and safe methods of prevention compared to those that are currently available. Moreover, research on biomarkers of early infection may be useful in early diagnosis and treatment of infections. The current manuscript reports an in-depth review and a position statement on bacterial infections in cirrhosis.

AB - Bacterial infections are very common and represent one of the most important reasons of progression of liver failure, development of liver-related complications, and mortality in patients with cirrhosis. In fact, bacterial infections may be a triggering factor for the occurrence of gastrointestinal bleeding, hypervolemic hyponatremia, hepatic encephalopathy, kidney failure, and development of acute-on-chronic liver failure. Moreover, infections are a very common cause of repeated hospitalizations, impaired health-related quality of life, and increased healthcare costs in cirrhosis. Bacterial infections develop as a consequence of immune dysfunction that occurs progressively during the course of cirrhosis. In a significant proportion of patients, infections are caused by gram-negative bacteria from intestinal origin, yet gram-positive bacteria are a frequent cause of infection, particularly in hospitalized patients. In recent years, infections caused by multidrug-resistant bacteria are becoming an important clinical problem in many countries. The reduction of the negative clinical impact of infections in patients with cirrhosis may be achieved by a combination of prophylactic measures, such as administration of antibiotics, to reduce the occurrence of infections in high-risk groups together with early identification and management of infection once it has developed. Investigation on the mechanisms of altered gut microflora, translocation of bacteria, and immune dysfunction may help develop more effective and safe methods of prevention compared to those that are currently available. Moreover, research on biomarkers of early infection may be useful in early diagnosis and treatment of infections. The current manuscript reports an in-depth review and a position statement on bacterial infections in cirrhosis.

KW - Cirrhosis

KW - Bacterial infection

KW - Multiresistant bacteria

KW - Diagnosis

KW - TUMOR-NECROSIS-FACTOR

KW - CHRONIC LIVER-FAILURE

KW - C-REACTIVE PROTEIN

KW - ACUTE-PHASE PROTEINS

KW - INCREASED INTESTINAL PERMEABILITY

KW - SYSTEMIC INFLAMMATORY RESPONSE

KW - CRITICALLY-ILL PATIENTS

KW - MESENTERIC LYMPH-NODES

KW - TNF-ALPHA PRODUCTION

KW - ALCOHOLIC CIRRHOSIS

U2 - 10.1016/j.jhep.2014.01.024

DO - 10.1016/j.jhep.2014.01.024

M3 - Article

SN - 0168-8278

VL - 60

SP - 1310

EP - 1324

JO - Journal of Hepatology

JF - Journal of Hepatology

IS - 6

ER -

Bacterial infections in cirrhosis: A position statement based on the EASL Special Conference 2013

Abstract

Keywords

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