Management of bacterial and fungal infections in cirrhosis: The MDRO challenge

JOURNAL OF HEPATOLOGY

卷:75

Review

Fernandez, Javier^1,2,3  Piano, Salvatore⁴  Bartoletti, Michele⁵  Wey, Emmanuel Q.^6,7,8 

[1] Univ Barcelona, Hosp Clin, Liver Unit, Liver ICU, Barcelona, Spain

[2] European Fdn Chron Liver Failure EF Clif, Barcelona, Spain

[3] ISCIII, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain

[4] Univ Padua, Dept Med DIMED, Unit Internal Med & Hepatol, Padua, Italy

[5] Alma Mater Studiorum Univ Bologna, Infect Dis Unit, Dept Med & Surg Sci, Bologna, Italy

[6] UCL, ILDH, Div Med, Med Sch, London, England

[7] UCL, Ctr Clin Microbiol, Div Infect & Immun, London, England

[8] Royal Free London NHS Trust London, Dept Infect, London, England

关键词: Epidemiology;    Prevalence;    Prognosis;    Antibiotic resistance;    Antibiotic strategies;   

DOI  :  10.1016/j.jhep.2020.11.010

来源: Elsevier

【 摘 要 】

Bacterial infections are frequent in cirrhotic patients with acute decompensation or acute-on-chronic liver failure and can complicate the clinical course. Delayed diagnosis and inappropriate empirical treatments are associated with poor prognosis and increased mortality. Fungal infections are much less frequent, usually nosocomial and associated with extremely high short-term mortality. Early diagnosis and adequate empirical treatment of infections is therefore key in the management of these patients. In recent decades, antibiotic resistance has become a major worldwide problem in patients with cirrhosis, warranting a more complex approach to antibiotic treatment that includes the use of broad-spectrum antibiotics, new administration strategies, novel drugs and de-escalation policies. Herein, we review epidemiological changes, the main types of multidrug-resistant organisms, mechanisms of resistance, new rapid diagnostic tools and currently available therapeutic options for bacterial and fungal infections in cirrhosis. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

Free