Infections complicating cirrhosis


Patients with cirrhosis have a high risk of bacterial infections. Bacterial infections induce systemic inflammation that may lead to organ failure and acute‐on‐chronic liver failure (ACLF) resulting in a high risk of short term mortality. The early diagnosis and treatment of bacterial infections is essential to improve the patient’s prognosis. However, in recent years, the spread of multidrug resistant (MDR) bacterial infections has reduced the efficacy of commonly used antibiotics such as third generation cephalosporins. In patients at high risk of MDR bacteria, such as those with nosocomial infections, the early administration of broad spectrum antibiotics has been shown to improve the prognosis. However, early de‐escalation of antibiotics is recommended to reduce a further increase in antibiotic resistance. Strategies to prevent acute kidney injury and other organ failures should be implemented. Although prophylaxis of bacterial infections with antibiotics improves the prognosis in selected patients, their use should be limited to patients at high risk of developing infections. In this article, we review the pathogenesis and management of bacterial infections in patients with cirrhosis.
acute‐on‐chronic liver failure, antibiotics, liver cirrhosis, sepsis, spontaneous bacterial peritonitis

About Speaker


Full Professor of Internal Medicine


City: Padova

Institution: Department of Medicine (DIMED), University of Padova


Biography of Paolo ANGELI

Prof. Paolo Angeli is Full Professor of Internal Medicine. He is the head of Unit of Internal Medicine and Hepatology of the University of Padova (Italy). He leads a research group working on the pathophysiology and treatment of acute, chronic and acute on chronic liver failure and on liver transplantation. He is the present secretary of the International Club of Ascites. He is author of more than 220 papers on international journals with peer review, cited by JCR. He has contributed to the guidelines and/or positional papers on the management of ascites, bacterial infections and acute renal injury (AKI) in patients with cirrhosis for the European Association for the Study of the Liver. He has contributed to the new diagnostic criteria for AKI in patients with cirrhosis as a result of a consensus process with almost all the international experts in this field.

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