Infecciones bacterianas en la cirrosis

  1. R. Martín-Mateos 1
  2. B. Mateos 1
  3. J.L. Lledó 1
  4. L. Téllez 1
  5. A. Albillos 1
  1. 1 Hospital Ramón y Cajal
    info

    Hospital Ramón y Cajal

    Madrid, España

    ROR https://ror.org/050eq1942

Revista:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Año de publicación: 2016

Título del ejemplar: Enfermedades del aparato digestivo (XII) Enfermedades hepáticas. Complicaciones de la cirrosis hepática

Serie: 12

Número: 12

Páginas: 666-672

Tipo: Artículo

DOI: 10.1016/J.MED.2016.05.020 DIALNET GOOGLE SCHOLAR

Otras publicaciones en: Medicine: Programa de Formación Médica Continuada Acreditado

Resumen

Introducción y patogenia Los pacientes cirróticos presentan infecciones bacterianas más graves y frecuentes que la población general. Esta predisposición se debe a las alteraciones inmunológicas y de la barrera intestinal que se desarrollan a lo largo de la evolución de su enfermedad. Epidemiología Las infecciones más habituales son la peritonitis bacteriana espontánea y las del tracto urinario, seguidas de las neumonías, celulitis y bacteriemias. Las bacterias gram-negativas de origen intestinal son el agente causal más frecuente, si bien en los últimos años ha aumentado el aislamiento de bacterias multirresistentes. Profilaxis, pronóstico y tratamiento La prevención, identificación precoz y tratamiento antibiótico adecuado son fundamentales para disminuir el impacto negativo de las infecciones en la supervivencia de los pacientes cirróticos.

Referencias bibliográficas

  • Fernández J, Navasa M, Gómez J, Colmenero J, Vila J, Arroyo V, et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology. 2002;35:140-8.
  • Borzio M, Salerno F, Piantoni L, Cazzaniga M, Angeli P, Bissoli F, et al. Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis. 2001;33:41-8.
  • Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al; CANONIC Study Investigators of the EASL–CLIF Consortium. Acute-on chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterolo-gy. 2013;144:1426-37.
  • Albillos A, Lario M, Álvarez-Mon M. Cirrhosis-associated immune dys-function: distinctive features and clinical relevance. J Hepatol. 2014;61:1385-96.
  • Lario M, Muñoz L, Ubeda M, Borrero MJ, Martínez J, Monserrat J, et al. Defective thymopoiesis and poor peripheral homeostatic replenishment of Thelper cells cause T-cell lymphopenia in cirrhosis. J Hepatol. 2013;59:723-30
  • Bolognesi M, Merkel C, Bianco S, Angeli P, Sacerdoti D, Amodio Pet al. Clinical significance of the evaluation of hepatic reticuloendothelial removal capacity in patients with cirrhosis. Hepatology. 1994;19:628-34.
  • Rimola A, Soto R, Bory F, Arroyo V, Piera C, Rodes J. Reticuloendothelial system phagocytic activity in cirrhosis and its relation to bacterial infections and prognosis. Hepatology. 1984;4:53-8.
  • Malik R, Mookerjee RP, Jalan R. Infection and inflammation in liver failure: two sides of the same coin. J Hepatol. 2009;51:426-9.
  • Wasmuth HE, Kunz D, Yagmur E, Timmer-Stranghöner A, Vidacek D, Siewert E, et al. Patients with acute on chronic liver failure display “sep-sis-like” immune paralysis. J Hepatol. 2005;42:195-201.
  • Assimakopoulos SF, Tsamandas AC, Tsiaoussis GI, Karatza E, Triantos C, Vagianos CE, et al. Altered intestinal tight junctions’ expression in patients with liver cirrhosis: a pathogenetic mechanism of intestinal hyperpermeability. Eur J Clin Invest. 2012;42:439-46.
  • Pascual S, Such J, Esteban A, Zapater P, Casellas JA, Aparicio JR, et al. Intestinal permeability is increased in patients with advanced cirrhosis. Hepatogastroenterology. 2003;50:1482-6.
  • Tsiaoussis GI, Assimakopoulos SF, Tsamandas AC, Triantos CK, Thomopoulos KC. Intestinal barrier dysfunction in cirrhosis: Current concepts in pathophysiology and clinical implications. World J Hepatol. 20157:2058-68.
  • Madrid AM, Cumsille F, Defilippi C. Altered small bowel motility in pa-tients with liver cirrhosis depends on severity of liver disease. Dig Dis Sci. 1997;42:738-42.
  • Bauer TM, Steinbrückner B, Brinkmann FE, Ditzen AK, Schwacha H, Aponte JJ, et al. Small intestinal bacterial overgrowth in patients with cirrhosis: prevalence and relation with spontaneous bacterial peritonitis. Am J Gastroenterol. 200196:2962–7.
  • Chang CS, Chen GH, Lien HC, Yeh HZ. Small intestine dysmotility and bacterial overgrowth in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology. 1998;28:1187-90.
  • Bernard B, Grangé JD, Khac EN, Amiot X, Opolon P, Poynard T. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology. 1999;29:1655-61.
  • Llach J, Rimola A, Navasa M, Ginès P, Salmerón JM, Ginès A, et al. Incidence and predictive factors of first episode of spontaneous bacterial peritonitis in cirrhosis with ascites: relevance of ascitic fluid protein concentration. Hepatology. 1992;16:724-7.
  • Ginés P, Rimola A, Planas R, Vargas V, Marco F, Almela M, et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial. Hep-atology. 1990;12:716-24.
  • Appenrodt B, Grünhage F, Gentemann MG, Thyssen L, Sauerbruch T, Lammert F. Nucleotide-binding oligomerization domain containing 2 (NOD2) variants are genetic risk factors for death and spontaneous bac-terial peritonitis in liver cirrhosis. Hepatology. 2010;51:1327-33.
  • Min YW, Lim KS, Min BH, Gwak GY, Paik YH, Choi MS, et al. Proton pump inhibitor use significantly increases the risk of spontaneous bacterial peritonitis in 1965 patients with cirrhosis and ascites: a propensity score matched cohort study. Aliment Pharmacol Ther. 2014;40:695-704
  • Bajaj JS, Ratliff SM, Heuman DM, Lapane KL. Proton pump inhibitors are associated with a high rate of serious infections in veterans with decompensated cirrhosis. Aliment Pharmacol Ther. 2012;36:866-74.
  • Van Vlerken LG, Huisman EJ, van Hoek B, Renooij W, de Rooij FW, Siersema PD, et al. Bacterial infections in cirrhosis: role of proton pump inhibitors and intestinal permeability. Eur J Clin Invest. 2012;42:760-7.
  • Zedtwitz-Liebenstein K, Wenisch C, Patruta S, Parschalk B, Daxböck F, Graninger W. Omeprazole treatment diminishes intra and extracellular neutrophil reactive oxygen production and bactericidal activity. Crit Care Med. 2002;30:1118-22.
  • Xu HB, Wang HD, Li CH, Ye S, Dong MS, Xia QJ, et al. Proton pump inhibitor use and risk of spontaneous bacterial peritonitis in cirrhotic patients: a systematic review and meta-analysis. Genet Mol Res. 2015;14:7490-501.
  • Trikudanathan G, Israel J, Cappa J, O'Sullivan DM. Association between proton pump inhibitors and spontaneous bacterial peritonitis in cirrhotic patients – a systematic review and meta-analysis. Int J Clin Pract. 2011;65:674-8.
  • Deshpande A, Pasupuleti V, Thota P, Pant C, Mapara S, Hassan S, et al. Acid-suppressive therapy is associated with spontaneous bacterial perito-nitis in cirrhotic patients: a meta-analysis. J Gastroenterol Hepatol. 2013;28:235-42.
  • Terg R, Casciato P, Garbe C, Cartier M, Stieben T, Mendizabal M, et al; Study Group of Cirrhosis Complications of the Argentine Association for the Study of Liver Disease. Proton pump inhibitor therapy does not increase the incidence of spontaneous bacterial peritonitis in cirrhosis: a multicenter prospective study. J Hepatol. 2015;62:1056-60.
  • Fernández J, Acevedo J. New antibiotic strategies in patients with cirrhosis and bacterial infection. Expert Rev Gastroenterol Hepatol. 2015;14:1-6.
  • Fernández J, Acevedo J, Castro M, García O, de Lope CR, Roca D, et al. Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study. Hepatology. 2012;55:1551-61.
  • Fernández J, Gustot T. Management of bacterial infections in cirrhosis. J Hepatol. 2012;56:S1-12.
  • Rimola A, García-Tsao G, Navasa M, Piddock LJ, Planas R, Ber-nard B, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol. 2000;32:142-53.
  • Papp M, Vitalis Z, Altorjay I, Tornai I, Udvardy M, Harsfalvi J, et al. Acute phase proteins in the diagnosis and prediction of cirrhosis associated bac-terial infections. Liver Int. 2012;32:603-11.
  • Albillos A, Cuervas-Mons V, Millán I, Cantón T, Montes J, Barrios C, et al. Ascitic fluid polymorphonuclear cell count and serum to ascites albu-min gradient in the diagnosis of bacterial peritonitis. Gastroenterology. 1990;98:134-40.
  • Mohan P, Ramu B, Bhaskar E, Venkataraman J. Prevalence and risk fac-tors for bacterial skin infection and mortality in cirrhosis. Ann Hepatol. 2011;10:15-20.
  • Ruiz-Morales J, Ivanova-Georgieva R, Fernández-Hidalgo N, García-Cabrera E, Miró JM, Muñoz P, et al; Spanish Collaboration on Endocarditis Group-Grupo de Apoyo al Manejo de la Endocarditis en España (GAMES); Spanish Network for Research in Infectious Diseases (REI-PI); Spanish Collaboration on Endocarditis Group-Grupo de Apoyo al Manejo de la Endocarditis en España GAMES. Left-sided infective en-docarditis in patients with liver cirrhosis. J Infect. 2015;71(6):627-41.
  • Arroyo V, Fernández J, Ginès P. Pathogenesis and treatment of hepatore-nal syndrome. Semin Liver Dis. 2008;28:81-95.
  • Follo A, Llovet JM, Navasa M, Planas R, Forns X, Francitorra A, et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology. 1994;20:1495-501.
  • Ruiz-del-Arbol L, Monescillo A, Arocena C, Valer P, Ginès P, Moreira V, et al. Circulatory function and hepatorenal syndrome in cirrhosis. Hepatology. 2005;42:439-47.
  • Ruiz-del-Arbol L, Urman J, Fernández J, González M, Navasa M, Monescillo A, et al. Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis. Hepa-tology. 2003;38:1210-8.
  • Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999;341:403-9.
  • Goulis J, Patch D, Burroughs AK. Bacterial infection in the pathogenesis of variceal bleeding. Lancet. 1999;353:139-42.
  • Merli M, Lucidi C, Pentassuglio I, Giannelli V, Giusto M, Di Gregorio V, et al. Increased risk of cognitive impairment in cirrhotic patients with bacterial infections. J Hepatol. 2013;59:243-50.
  • Plessier A, Denninger MH, Consigny Y, Pessione F, Francoz C, Durand F, et al. Coagulation disorders in patients with cirrhosis and severe sepsis. Liver Int. 2003;23:440-8.
  • Fede G, Spadaro L, Tomaselli T, Privitera G, Scicali R, Vasianopoulou P, et al. Comparison of total cortisol, free cortisol, and surrogate markers of free cortisol in diagnosis of adrenal insufficiency in patients with stable cirrhosis. Clin Gastroenterol Hepatol. 2014;12:504-12.
  • Tsai MH, Peng YS, Chen YC, Liu NJ, Ho YP, Fang JT, et al. Adrenal insufficiency in patients with cirrhosis, severe sepsis and septic shock. Hepatology. 2006;43:673-81.
  • European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53:397-417.
  • Jalan R, Fernández J, Wiest R, Schnabl B, Moreau R, Angeli P, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol. 2014;60:1310-24.
  • Cohen MJ, Sahar T, Benenson S, Elinav E, Brezis M, Soares-Weiser K. Antibiotic prophylaxis for spontaneous bacterial peritonitis in cirrhotic patients with ascites, without gastro-intestinal bleed-ing. Cochrane Database Syst Rev. 2009;15:CD004791.
  • Fernández J, Navasa M, Planas R, Montoliu S, Monfort D, Sori-ano G, et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology. 2007;133:818-24.
Fuente de los datos: Dialnet