title: Novel prevention strategies for bacterial infections in cirrhosis.
abstract: BACKGROUND
  Bacterial infections are a serious complication of cirrhosis, as they can lead to decompensation, multiple organ failure, and/or death. Preventing infections is therefore very relevant. Because gut bacterial translocation is their main pathogenic mechanism, prevention of infections is mostly based on the use of orally administered poorly absorbed antibiotics such as norfloxacin (selective intestinal decontamination). However, antibiotic prophylaxis leads to antibiotic resistance, limiting therapy and increasing morbidity and mortality. Prevention of bacterial infections in cirrhosis should therefore move away from antibiotics.
  
  
  METHODS
  This review focuses on various potentially novel methods to prevent infections in cirrhosis focusing on non-antibiotic strategies. The use of probiotics, nonselective intestinal decontamination with rifaximin, prokinetics and beta-blockers or fecal microbiota transplant as means of targeting altered gut microbiota, bile acids and FXR agonists are all potential alternatives to selective intestinal decontamination. Prokinetics and beta-blockers can improve intestinal motility, while bile acids and FXR agonists help by improving the intestinal barrier. Finally, granulocyte colony stimulating factor (G-CSF) and statins are emerging therapeutic strategies that may improve immune dysfunction in cirrhosis.
  
  
  CONCLUSIONS
  Evidence for these strategies has been restricted to animal studies and proof-of concept studies but we expect this to change in coming years.
authors.affiliation: a Digestive Diseases Section , Yale University School of Medicine , New Haven , CT , USA.|b Digestive Diseases Section , VA-CT Healthcare System , West Haven , CT , USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Yan
authors.affiliation: a Digestive Diseases Section , Yale University School of Medicine , New Haven , CT , USA.|b Digestive Diseases Section , VA-CT Healthcare System , West Haven , CT , USA.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Garcia-Tsao
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000517:prevention & control*; D018988:Bacterial Translocation; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D005769:Gastrointestinal Motility; D006801:Humans; D007422:Intestines / Q000382:microbiology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications*; D019936:Probiotics / Q000627:therapeutic use*; D012294:Rifamycins / Q000627:therapeutic use; D000078262:Rifaximin
chemical_list: D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents; D012294:Rifamycins; D000078262:Rifaximin
keywords: Cirrhosis; FXR agonist; GCSF; bacterial infections; bacterial translocation; beta-blockers; bile acids; fecal microbiota transplant; probiotics; prokinetics; rifaximin; selective intestinal decontamination; statins