Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions

Patients with liver cirrhosis are susceptible to infections due to various mechanisms, including abnormalities of humoral and cell-mediated immunity and occurrence of bacterial translocation from the intestine. Bacterial infections are common and represent a reason for progression to liver failure a...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2018-10, Vol.24 (38), p.4311-4329
Main Author: Righi, Elda
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - adverse effects
Anti-Bacterial Agents - therapeutic use
Antifungal Agents - adverse effects
Antifungal Agents - therapeutic use
Bacterial Infections - drug therapy
Bacterial Infections - immunology
Bacterial Infections - microbiology
Bacterial Infections - mortality
Candida - isolation & purification
Candida - pathogenicity
Disease Progression
Drug Resistance, Multiple, Bacterial - drug effects
End Stage Liver Disease - complications
End Stage Liver Disease - immunology
End Stage Liver Disease - mortality
End Stage Liver Disease - therapy
Gram-Negative Bacteria - isolation & purification
Gram-Negative Bacteria - pathogenicity
Humans
Infection Control - methods
Liver Transplantation
Microbial Sensitivity Tests
Mycoses - drug therapy
Mycoses - immunology
Mycoses - microbiology
Mycoses - mortality
Review
Staphylococcus - isolation & purification
Staphylococcus - pathogenicity
Waiting Lists - mortality
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Summary:Patients with liver cirrhosis are susceptible to infections due to various mechanisms, including abnormalities of humoral and cell-mediated immunity and occurrence of bacterial translocation from the intestine. Bacterial infections are common and represent a reason for progression to liver failure and increased mortality. Fungal infections, mainly caused by spp., are often associated to delayed diagnosis and high mortality rates. High level of suspicion along with prompt diagnosis and treatment of infections are warranted. Bacterial and fungal infections negatively affect the outcomes of liver transplant candidates and recipients, causing disease progression among patients on the waiting list and increasing mortality, especially in the early post-transplant period. Abdominal, biliary tract, and bloodstream infections caused by Gram-negative bacteria [ ., and ( )] and spp. are commonly encountered in liver transplant recipients. Due to frequent exposure to broad-spectrum antibiotics, invasive procedures, and prolonged hospitalizations, these patients are especially at risk of developing infections caused by multidrug resistant bacteria. The increase in antimicrobial resistance hampers the choice of an adequate empiric therapy and warrants the knowledge of the local microbial epidemiology and the implementation of infection control measures. The main characteristics and the management of bacterial and fungal infections in patients with liver cirrhosis and liver transplant recipients are presented.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v24.i38.4311