• Rajiv Jalan, Javier Fernandez, Reiner Wiest, Bernd Schnabl, Richard Moreau, Paolo Angeli, Vanessa Stadlbauer, Thierry Gustot, Mauro Bernardi, Rafael Canton, Agustin Albillos, Frank Lammert, Alexander Wilmer, Rajeshwar Mookerjee, Jordi Vila, Rita Garcia-Martinez, Julia Wendon, José Such, Juan Cordoba, Arun Sanyal, Guadalupe Garcia-Tsao, Vicente Arroyo, Andrew Burroughs, and Pere Ginès.
• Liver Failure Group, UCL Institute for Liver and Digestive Health, Royal Free Hospital, UK.
• J. Hepatol. 2014 Jun 1; 60 (6): 1310-24.

AbstractBacterial infections are very common and represent one of the most important reasons of progression of liver failure, development of liver-related complications, and mortality in patients with cirrhosis. In fact, bacterial infections may be a triggering factor for the occurrence of gastrointestinal bleeding, hypervolemic hyponatremia, hepatic encephalopathy, kidney failure, and development of acute-on-chronic liver failure. Moreover, infections are a very common cause of repeated hospitalizations, impaired health-related quality of life, and increased healthcare costs in cirrhosis. Bacterial infections develop as a consequence of immune dysfunction that occurs progressively during the course of cirrhosis. In a significant proportion of patients, infections are caused by gram-negative bacteria from intestinal origin, yet gram-positive bacteria are a frequent cause of infection, particularly in hospitalized patients. In recent years, infections caused by multidrug-resistant bacteria are becoming an important clinical problem in many countries. The reduction of the negative clinical impact of infections in patients with cirrhosis may be achieved by a combination of prophylactic measures, such as administration of antibiotics, to reduce the occurrence of infections in high-risk groups together with early identification and management of infection once it has developed. Investigation on the mechanisms of altered gut microflora, translocation of bacteria, and immune dysfunction may help develop more effective and safe methods of prevention compared to those that are currently available. Moreover, research on biomarkers of early infection may be useful in early diagnosis and treatment of infections. The current manuscript reports an in-depth review and a position statement on bacterial infections in cirrhosis. Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

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