Cited by 908Liver Disease and TransplantationSepsis Diagnosis and TreatmentGut microbiota and health

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

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Jalan, Rajiv, Fernandez, Javier, Wiest, Reiner, Schnabl, Bernd, Moreau, Richard, Angeli, Paolo, Stadlbauer, Vanessa, Gustot, Thierry, Bernardi, Mauro, Canton, Rafael, Albillos, Agustin, Lammert, Frank, Wilmer, Alexander, Mookerjee, Rajeshwar, Vila, Jordi, Garcia-Martinez, Rita, Wendon, Julia, Such, José, Cordoba, Juan, Sanyal, Arun, Garcia-Tsao, Guadalupe, Arroyo, Vicente, Burroughs, Andrew, Ginès, Pere·2014·Journal of Hepatology

DOI 10.1016/j.jhep.2014.01.024

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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.

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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: Jalan, Rajiv
Wiest, Reiner
Schnabl, Bernd
Moreau, Richard
Angeli, Paolo
Stadlbauer, Vanessa
Gustot, Thierry
Bernardi, Mauro
Lammert, Frank
Wilmer, Alexander
Mookerjee, Rajeshwar
Wendon, Julia
Such, José
Sanyal, Arun
Arroyo, Vicente
Burroughs, Andrew
Ginès, Pere
Venue: Journal of Hepatology
Publisher: Elsevier BV
Published: 2014-06
Volume: 60
Issue: 6
Pages: 1310-1324
ISSN: 0168-8278 (ISSN-L)
DOI: 10.1016/j.jhep.2014.01.024
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: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
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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Bacterial infections in cirrhosis: A position statement based on the EASL Special Conference 2013

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