[TREATMENT AND PREVENTION OF BACTERIAL AND MYCOTICINFECTION IN ACUTE LIVER FAILURE]
Patients with acute liver failure (ALF) have increased susceptibility to nosocomial and opportunistic infections as a result of various immune defects and the need for invasive monitoring procedures. Bacteriologically proven infection was recorded in up to 80% of these patients and, fungal infection in 32%. Clinical signs such as high temperature and high WBC are absent in 30% of the cases. These patients are prone to develop multiple and concomitant infections. The most common infection in ALF patients is pneumonia, accounting for 50% of episodes. These infections occurs early in the course of the disease. Selective parenteral and enteral antisepsis regimens (SPEAR) were evaluated in prospective controlled studies. Although in a initial study there was an overall reduction of infection episodes. A recent study has shown that the administration of oral non-absorbable antibacterials did not confer any additional benefit over prophylactic systemic antibacterials. In conclusion it is clear that antimicrobial prophylaxis does dramatically reduce the risk of infectious complications and contribute to the improvement in mortality from ALF.
Rolando N
Nancy
DRA