DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20162481

Bacterial infections in cirrhosis - does standard empirical therapy need a rethink?

Shiran Shetty, Venkatakrishnan Leelakrishnan, Krishnaveni Janarthanan

Abstract


Background: Patients with cirrhosis not only have a higher incidence and a greater severity of infections but infections increase the mortality and morbidity in cirrhosis. Third-generation cephalosporins and quinolones are currently the most commonly recommended first-line empirical therapy in most infections. This study was conducted to study the bacterial etiology, susceptibility of these organisms to these commonly used antibiotics.

Methods: All patients of cirrhosis of liver admitted to a tertiary care centre underwent cultures from blood, urine and ascitic fluid and the incidence of infection was calculated. Sensitivity pattern of organisms to third generation cephalosporins and quinolones were studied.

Results: A total of 150 patients were included in the study and 58 (37.8%) of them had one or more infections. Spontaneous bacterial peritonitis was the most common infection noted and gram-negative bacilli (E. coli) were the commonest organisms isolated. The overall response rate to quinolones and third generation cephalosporin’s was only 47%.

Conclusions: Increasing use of antibiotics in empirical role has increased resistance to commonly used antibiotics. Empirical therapy should be decided based upon local epidemiological patterns and the same cannot be generalized.


Keywords


Cirrhosis, Infection, Empirical therapy, Antibiotic resistance

Full Text:

PDF

References


Racanelli V, Rehermann B. The liver as an immunological organ. Hepatology. 2006;43(2 Suppl 1):S54-62.

Roselle GA, Mendenhall CL. Alteration of in vitro human lymphocyte functions by ethanol, acetaldehyde and acetate. J Clin Lab Immunol. 1982;9(1):33-7.

Deschênes M, Villeneuve JP. Risk factors for the development of bacterial infections in hospitalized patients with cirrhosis. Am J Gastroenterol. 1999;94(8):2193-7.

Jalan R, Fernandez J, Wiest R, Schnabl B, Moreau R, Angeli P, et al. Bacterial infections in cirrhosis: A position statement based on the EASL Special Conference 2013. J Hepatol. 2014;60(6):1310-24.

Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144(7):1426-37.

European association for the study of the liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53:397-417.

Runyon BA. Management of adult patients with ascites due to cirrhosis: an update. Hepatology. 2009;49(6):2087-107.

Wong F, Bernardi M, Balk R, Christman B, Moreau R, Garcia-Tsao G, et al. Sepsis in cirrhosis: report on the 7th meeting of the International Ascites Club. Gut. 2005;54(5):718-25.

Suárez C, Pajares JM. Epidemiology of infections in liver cirrhosis. Rev Clin Esp. 1981;160(5):299-303.

Rimola A, Bory F, Planas R, Xaubet A, Bruguera M RJ. Infecciones bacterianas agudas en la cirrosis hepática. Gastroenterol Hepatol. 1981;4:453-8.

Palazón JM, Garcia AGA. Infecciones hospitalarias en pacientes con cirrosis hepática. Gastroenterol Hepatol. 1984;7:120-2.

Levi D, Terg R, Podesta A, Abecasis R, de Gle G RC. Infecciones bacterianas en el paciente cirrótico. Gastroenterol Hepatol. 1989;12:384-8.

Clemente G, Barajas JM, Serrano MI, Pérez de Ayala MV, Menchén P, Senent MC, et al. Infecciones bacterianas en la cirrosis hepática. Gastroenterol Hepatol. 1986;9:285-90.

Caly WR, Strauss E. A prospective study of bacterial infections in patients with cirrhosis. J Hepatol. 1993;18(3):353-8.

Andreu M, Barrufet P, Force L, Solá R, Verdaguer A, Panadés AAR. Fiebre en el enfermo con cirrosis hepática: estudio prospectivo durante 6 meses. Med Clin. 1985;84:433-6.

Fernández J, Navasa M, Gómez J, Colmenero J, Vila J, Arroyo V, et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology. 2002;35(1):140-8.

Borzio M, Salerno F, Piantoni L, Cazzaniga M, Angeli P, Bissoli F, et al. Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis. 2001;33(1):41-8.

Merli M, Lucidi C, Giannelli V, Giusto M, Riggio O, Falcone M, et al. Cirrhotic patients are at risk for health care-associated bacterial infections. Clin Gastroenterol Hepatol. 2010;8(11):979-85.

Fernández J, Acevedo J, Castro M, Garcia O, de Lope CR, Roca D, et al. Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study. Hepatology. 2012;55(5):1551-61.