par Gustot, Thierry ;Moreau, Richard
Référence Cirrhosis: a practical guide to diagnosis and management., Wiley Blackwell, Ed. 1
Publication Publié, 2015-01-30
Partie d'ouvrage collectif
Résumé : Bacterial infection has become the leading cause of death in patients with cirrhosis. This susceptibility is explained by the paradoxical association of an immune defect in the clearance of bacteria and an overexpression of pro-inflammatory mediators responsible of sepsis-related organ failure. Bacterial infections must be suspected and screened for in all patients with decompensated cirrhosis. Spontaneous bacterial peritonitis (SBP) and urinary tract infection (UTI) are the most frequent types of infection followed by pneumonia, skin and soft tissue infection (SSTI), spontaneous bacteremia, and catheter-related infections. The prompt initiation of an adequate antibiotic therapy is the key to effective management. Broad use of long-term quinolones for prophylaxis and an increasing use of invasive procedures contributes to the development of multidrug-resistant bacteria. The choice of an adequate empiric antibiotic becomes a challenge, particularly in nosocomial infections. The administration of intravenous albumin can prevent the development of organ failure, at least in SBP. Sepsis-related organ failures are associated with a very poor outcome in cirrhotic patients. Multiple prophylactic strategies are effective in preventing bacterial infection in high-risk cirrhotic patients.