title: Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013.
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.
authors: Liver Failure Group, UCL Institute for Liver and Digestive Health, Royal Free Hospital, UK.
authors: Rajiv
authors: R
authors: Jalan
authors: Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
authors: Javier
authors: J
authors: Fernandez
authors: Department of Gastroenterology, UVCM, Inselspital, 3010 Bern, Switzerland.
authors: Reiner
authors: R
authors: Wiest
authors: Department of Medicine, University of California San Diego, La Jolla, CA, USA.
authors: Bernd
authors: B
authors: Schnabl
authors: INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, UMRS 773, Université Paris-Diderot Paris, Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.
authors: Richard
authors: R
authors: Moreau
authors: Unit of Hepatic Emergencies and Liver Transplantation, Department of Medicine, University of Padova, Italy.
authors: Paolo
authors: P
authors: Angeli
authors: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Austria.
authors: Vanessa
authors: V
authors: Stadlbauer
authors: Department of Gastroenterology and Hepato-Pancreatology, Erasme Hospital, Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium.
authors: Thierry
authors: T
authors: Gustot
authors: Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors: Mauro
authors: M
authors: Bernardi
authors: Department of Microbiology, Hospital Universitario Ramón y Cajal and Intituto Ramon y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
authors: Rafael
authors: R
authors: Canton
authors: Gastroenterology Service, University Hospital Ramon y Cajal, Madrid, Spain.
authors: Agustin
authors: A
authors: Albillos
authors: Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
authors: Frank
authors: F
authors: Lammert
authors: Medical Intensive Care Unit, University Hospital Gasthuisberg, Leuven, Belgium.
authors: Alexander
authors: A
authors: Wilmer
authors: Liver Failure Group, UCL Institute for Liver and Digestive Health, Royal Free Hospital, UK.
authors: Rajeshwar
authors: R
authors: Mookerjee
authors: Department of Microbiology, Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain.
authors: Jordi
authors: J
authors: Vila
authors: Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
authors: Rita
authors: R
authors: Garcia-Martinez
authors: Institute of Liver Studies and Critical Care, Kings College London, Kings College Hospital, UK.
authors: Julia
authors: J
authors: Wendon
authors: Department of Clinical Medicine, Miguel Hernández University, Alicante, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
authors: José
authors: J
authors: Such
authors: Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
authors: Juan
authors: J
authors: Cordoba
authors: Charles Caravati Professor of Medicine, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors: Arun
authors: A
authors: Sanyal
authors: Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA.
authors: Guadalupe
authors: G
authors: Garcia-Tsao
authors: Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
authors: Vicente
authors: V
authors: Arroyo
authors: The Royal Free Shelia Sherlock Liver Centre and University Department of Surgery, University College London and Royal Free Hospital, UK.
authors: Andrew
authors: A
authors: Burroughs
authors: Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: pgines@clinic.ub.es.
authors: Pere
authors: P
authors: Ginès
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications* / Q000188:drug therapy*; D024881:Drug Resistance, Bacterial; D005762:Gastroenterology / Q000592:standards*; D006801:Humans; D008103:Liver Cirrhosis / Q000382:microbiology*; D017410:Practice Guidelines as Topic
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacterial infection; Cirrhosis; Diagnosis; Multiresistant bacteria