par Gustot, Thierry ;Moreau, Richard
Référence Complications of Cirrhosis: Evaluation and Management, Springer International Publishing, page (229-241)
Publication Publié, 2015-01
Partie d'ouvrage collectif
Résumé : Bacterial infections are the cause of death in cirrhosis. In Western countries, bacterial infection is the principal identifiable precipitating event of acute-on-chronic liver failure (ACLF) which is associated with high short-term mortality. Bacterial translocation due to increased gut permeability and intestinal bacterial overgrowth/dysbiosis contributes mainly to the susceptibility of cirrhotic patients to develop bacterial infections. The diagnosis of bacterial infection in cirrhosis is challenging due to the lack of sensitive and specific classical clinical and biological parameters. The early diagnosis of bacterial infections and the prompt initiation of adequate antibiotic treatment are the cornerstone of management. Due to the frequent use of broad-spectrum antibiotics and increased invasiveness of procedures, nonclassical pathogen and multiresistant bacteria are increasingly reported. Third generation cephalosporins continue to be the gold-standard antibiotic treatment of many of the infections acquired in the community. By contrast, the empirical treatment of nosocomial infections should be tailored according to the local epidemiological pattern of multiresistant bacteria.