Bacterial Infection in Cirrhosis: Clinical Significance
의약학 > 내과학
Single Topic Symposium (STS) 2012년, 제2012권 제2호, 1~12페이지(총12페이지)
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    Bacterial infection is a well-known complication in patients with liver cirrhosis, with a significantly high mortality in hospitalized patients. Cirrhosis is an immunocompromised state, which predisposes the patient to a variety of infections. Despite the improved understanding of the pathogenesis of bacteremia or sepsis, reported data indicate that bacterial infection in cirrhotic patients is still associated with poor prognosis, and there has been little improvement of the patient outcome in recent decades. Studies show a 4- or 5-fold increase in the infection rate among patients with cirrhosis, compared to those without cirrhosis. Hospitalized cirrhotic patients with gastrointestinal bleeding are at a particularly high risk of bacterial infection, with a reported rate of up to 45%. The most common bacterial infections are spontaneous bacterial peritonitis (25-31%), urinary tract infection (20-25%), pneumonia (15-21%), bacteremia (12%), and soft tissue infection (11%). A greater proportion of these cases are caused by gram-negative bacteria, such as Escherichia coli, Klebsiella spp., Enterobacter spp., and P. aeruginosa, but a number of other bacterial and fungal pathogens are more common and virulent in patients with cirrhosis. Recently, uncommon and drug-resistant organisms are reported to be frequently encountered in cirrhotic patients who are hospitalized, received quinolones prophylaxis and had invasive procedures, causing a suboptimal or poor response to standard antibiotic therapy. Early recognition and appropriate empirical antibiotic treatment are essential in the outcome of these patients. This topic review will summarize clinical issues related to bacterial infection in patients with liver cirrhosis, focusing epidemiology, clinical manifestation, treatment, and prophylaxis.
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