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Bacterial infections in cirrhosis: A position statement based on the EASL Special Conference 2013
Open accessAbstract
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.
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“Norfloxacin, a poorly absorbed quinolone, is currently one of the drugs of choice for the primary or secondary prophylaxis of spontaneous bacterial peritonitis and infections in high-risk patients with cirrhosis 108.”
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Treatment of spontaneous bacterial peritonitis: beyond the current international guidelines
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Self-citationEfficacy of albumin use in decompensated cirrhosis and real‐world adoption in Australia
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Self-citation
Metadata
- Authors
- 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., & Ginès, P.
- Affiliations
- The Royal Free Hospital (GB)
- University Hospital of Bern (CH)
- University of California San Diego (US)
- Inserm (FR)
- University of Padua (IT)
- Medical University of Graz (AT)
- Université Libre de Bruxelles (BE)
- University of Bologna (IT)
- Universitätsklinikum des Saarlandes (DE)
- Universitair Ziekenhuis Leuven (BE)
- King's College London (GB)
- Instituto de Salud Carlos III (ES)
- Virginia Commonwealth University (US)
- Corresponding author
- Ginès, Pere
- ORCID
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2014-06
- Volume
- 60
- Issue
- 6
- Pages
- 1310-1324
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W2136919496
- Cited by
- 906
- References
- 165
- Citations by year
- 2026: 35 · 2025: 52 · 2024: 63 · 2023: 56 · 2022: 88 · 2021: 105 · 2020: 83 · 2019: 79 · 2018: 102 · 2017: 84 · 2016: 72 · 2015: 65 · 2014: 22
- FWCI
- 45.19
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Hepatology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- BORIS (University Library Bern) (submittedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Lirias (KU Leuven) (submittedVersion, cc-by-nc-nd)
- Padua Research Archive (University of Padova) (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, cc-by-nc-nd)
- Funders
- Fondo de Investigación Sanitaria (FIS PI08/0126, FIS PI12/00330)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- bacterial infection, liver cirrhosis, immune dysfunction, Gram-negative bacteria, Gram-positive bacteria, multidrug-resistant bacteria, infection control, antibiotic prophylaxis, gut microbiota, bacterial translocation, acute-on-chronic liver failure, infection biomarkers, early infection detection, hospitalization
- MeSH terms
- Anti-Bacterial Agents, Bacterial Infections, Gastroenterology, Humans, Liver Cirrhosis, Practice Guidelines as Topic, Drug Resistance, Bacterial
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