title: Bloodstream infections in patients with liver cirrhosis.
abstract: Bloodstream infections are a serious complication in patients with liver cirrhosis. Dysregulated intestinal bacterial translocation is the predominant pathophysiological mechanism of infections in this setting. For this reason enteric Gram-negative bacteria are commonly encountered as the first etiological cause of infection. However, through the years, the improvement in the management of cirrhosis, the recourse to invasive procedures and the global spread of multidrug resistant pathogens have importantly changed the current epidemiology. Bloodstream infections in cirrhotic patients are characterized by high mortality rate and complications including metastatic infections, infective endocarditis, and endotipsitis (or transjugular intrahepatic portosystemic shunt-related infection). For this reason early identification of patients at risk for mortality and appropriated therapeutic management is mandatory. Liver cirrhosis can significantly change the pharmacokinetic behavior of antimicrobials. In fact hypoproteinaemia, ascitis and third space expansion and impairment of renal function can be translated in an unpredictable drug exposure.
authors: a Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna , Bologna , Italy.
authors: Michele
authors: M
authors: Bartoletti
authors: a Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna , Bologna , Italy.
authors: Maddalena
authors: M
authors: Giannella
authors: a Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna , Bologna , Italy.
authors: Russell Edward
authors: RE
authors: Lewis
authors: a Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna , Bologna , Italy.
authors: Pierluigi
authors: P
authors: Viale
mesh_terms: D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D018988:Bacterial Translocation; D004697:Endocarditis, Bacterial / Q000150:complications / Q000453:epidemiology; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification / Q000502:physiology; D006801:Humans; D007019:Hypoproteinemia / Q000150:complications; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: bacteremia; bloodstream infections; epidemiology; liver cirrhosis; pathophysiology; therapeutic management