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Krywanczyk A, Gilson T. The Forensic Perspective of Infectious Endocarditis: A Retrospective Study With Recommendations for the Future. Am J Forensic Med Pathol 2024; 45:287-291. [PMID: 38833326 DOI: 10.1097/paf.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Increasing rates of infectious endocarditis (IE) are well-described in the United States and worldwide, yet forensic literature regarding IE is sparse. Autopsy databases may help identify subsets of patients at increased risk of mortality. We reviewed all deaths due to IE in our office between 2010 and 2022 (with full autopsy performed) and found 29. The average age was 44 years. Manners of death included natural (69%), accident (28%), and homicide (3%). For all accidental deaths, acute intoxication was included in either part I or II. The aortic valve was most affected (62%), followed by tricuspid (28%) and mitral (24%). Seventy-six percent of affected valves were native, and 24% were prosthetic. Common risk factors included intravenous drug use (48%) and chronic ethanolism (21%). No sustained increase in deaths due to IE was identified. These data show marked differences from clinical literature, including a lower average age and higher incidence of substance use disorders, and it is unlikely selection bias is the sole reason. There was inconsistency in death certification, most notably by not including pertinent IE risk factors. Improving consistency and quality of IE death certification will aid in detecting regional trends and assist multi-institutional collaboration efforts.
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Van Hemelrijck M, Sromicki J, Frank M, Greutmann M, Ledergerber B, Epprecht J, Padrutt M, Vogt PR, Carrel TP, Dzemali O, Mestres CA, Hasse B. Dismal prognosis of patients with operative indication without surgical intervention in active left-sided infective endocarditis. Front Cardiovasc Med 2023; 10:1223878. [PMID: 37692048 PMCID: PMC10491846 DOI: 10.3389/fcvm.2023.1223878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/28/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Around 25% of patients with left-sided infective endocarditis and operative indication do not undergo surgery. Baseline characteristics and outcomes are underreported. This study describes characteristics and outcomes of surgical candidates with surgical intervention or medical treatment only. Methods Retrospective analysis of ongoing collected data from a single-center from an observational cohort of patients with infective endocarditis (ENVALVE). Kaplan-Meier estimates for survival was calculated. Factors associated with survival were assessed using a bivariable Cox model. To adjust for confounding by indication, uni- and multivariable logistic regression for the propensity to receive surgery were adjusted. Results From January 2018 and December 2021, 154 patients were analyzed: 116 underwent surgery and 38 received medical treatment only. Surgical candidates without surgery were older (70 vs. 62 years, p = 0.001). They had higher preoperative risk profile (EuroSCORE II 14% (7.2-28.6) vs. 5.8% (2.5-20.3), p = 0.002) and more comorbidities. One patient was lost-to-follow-up. Survival analysis revealed a significant higher one-year survival rate among patients following surgery (83.7% vs. 15.3% in the non-surgical group; log-rank test <0.0001). In the final multivariable adjusted model, surgery was less likely among patients with liver cirrhosis [OR = 0.03 (95% CI 0.00-0.30)] and with hemodialysis [OR = 0.014 (95% CI 0.00-0.47)]. Conclusion Patients with left-sided infective endocarditis who do not undergo surgery despite an operative indication are older, have more comorbidities and therefore higher preoperative risk profile and a low 1-year survival. The role of the Endocarditis Team may be particularly important for the decision-making process in this specific group.
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Affiliation(s)
| | - Juri Sromicki
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Michelle Frank
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Greutmann
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Bruno Ledergerber
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Jana Epprecht
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Maria Padrutt
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Paul R. Vogt
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Thierry P. Carrel
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Carlos-A. Mestres
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Barbara Hasse
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
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Alhendi F. A Patient with Alcoholic Liver Disease Reports for Treatment of Dentoalveolar Abscess in Relation to Maxillary Left Molar. Dent Clin North Am 2023; 67:549-552. [PMID: 37244738 DOI: 10.1016/j.cden.2023.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Dental management of patients with alcoholic liver disease (ALD) depends on the understanding of the systemic effects of liver disease on the body's various systems. ALD can affect normal hemostatic functions by affecting platelets and coagulation factors resulting in prolonged postoperative bleeding. Given these facts, a complete blood count, liver function test, and coagulation profile should be requested before oral surgical procedures. Because the liver is an organ for drug metabolism and detoxification, liver disease may cause increased or decreased drug metabolism and hence alteration of drugs effectiveness and/or increase toxicity. Prophylactic antibiotics may be required to prevent serious infections.
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Affiliation(s)
- Fatmah Alhendi
- Ministry of health, Al Sulaibikhat, Jamal Abdulnasser Street, P.O. Box:5, Kuwait city, Kuwait.
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Wijarnpreecha K, Fontana RJ. Watch out for the Saurkraut: Weissella confusa endocarditis in a liver transplant candidate. Clin Liver Dis (Hoboken) 2022; 20:188-193. [PMID: 36523861 PMCID: PMC9745257 DOI: 10.1002/cld.1256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/13/2022] [Accepted: 08/04/2022] [Indexed: 12/15/2022] Open
Abstract
Content available: Audio Recording.
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Affiliation(s)
- Karn Wijarnpreecha
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMichiganUSA
| | - Robert J. Fontana
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMichiganUSA
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Monteith AJ, Miller JM, Beavers WN, Juttukonda LJ, Skaar EP. Increased Dietary Manganese Impairs Neutrophil Extracellular Trap Formation Rendering Neutrophils Ineffective at Combating Staphylococcus aureus. Infect Immun 2022; 90:e0068521. [PMID: 35191757 PMCID: PMC8929375 DOI: 10.1128/iai.00685-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/06/2022] [Indexed: 11/20/2022] Open
Abstract
Dietary metals can modify the risk to infection. Previously, we demonstrated that heightened dietary manganese (Mn) during systemic Staphylococcus aureus infection increases S. aureus virulence. However, immune cells also operate in these same environments and the effect of dietary Mn on neutrophil function in vivo has not been assessed. This study reveals that increased concentrations of Mn impairs mitochondrial respiration and superoxide production in neutrophils responding to S. aureus. As a result, high Mn accelerates primary degranulation, while impairing suicidal neutrophil extracellular trap (NET) formation, which decreases bactericidal activity. In vivo, elevated dietary Mn accumulated extracellularly in the heart, indicating that excess Mn may be more bioavailable in the heart. Coinciding with this phenotype, neutrophil function in the heart was most impacted by a high Mn diet, as neutrophils produced lower levels of mitochondrial superoxide and underwent less suicidal NET formation. Consistent with an ineffective neutrophil response when mice are on a high Mn diet, S. aureus burdens were increased in the heart and mice were more susceptible to systemic infection. Therefore, elevated dietary Mn not only affects S. aureus but also renders neutrophils less capable of restricting staphylococcal infection.
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Affiliation(s)
- Andrew J. Monteith
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeanette M. Miller
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William N. Beavers
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pathobiological Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana, USA
| | - Lillian J. Juttukonda
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric P. Skaar
- Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Institute for Infection, Immunology, & Inflammation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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6
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Abstract
The management of infective endocarditis is complex and inherently requires multidisciplinary cooperation. About half of all patients diagnosed with infective endocarditis will meet the criteria to undergo cardiac surgery, which regularly takes place in urgent or emergency settings. The pathophysiology and clinical presentation of infective endocarditis make it a unique disorder within cardiac surgery that warrants a thorough understanding of specific characteristics in the perioperative period. This includes, among others, echocardiography, coagulation, bleeding management, or treatment of organ dysfunction. In this narrative review article, the authors summarize the current knowledge on infective endocarditis relevant for the clinical anesthesiologist in perioperative management of respective patients. Furthermore, the authors advocate for the anesthesiologist to become a structural member of the endocarditis team.
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7
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Incidence of Gastrointestinal Bleeding after Transesophageal Echocardiography in Patients with Gastroesophageal Varices: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr 2021; 35:387-394. [PMID: 34875315 DOI: 10.1016/j.echo.2021.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Transesophageal echocardiography (TEE) is useful for cardiac assessment and intraoperative monitoring. However, the safety of TEE in patients with cirrhosis and gastroesophageal varices has remained uncertain. The aim of this meta-analysis was to determine the incidence of gastrointestinal bleeding after TEE in patients with varices. The secondary objectives were to compare bleeding risks between patients with and without varices and to determine the incidence of TEE-related esophageal perforation and mortality. METHODS A systematic literature search was conducted on MEDLINE, Embase, and the Cochrane Library using the terms "transesophageal echocardiography," "varices," "bleeding," and related terms. Articles describing the incidence of post-TEE bleeding in patients with varices were included. Non-English-language articles were excluded. Risk of bias and level of evidence were assessed using validated scales. The pooled weighted incidence of gastrointestinal bleeding and the risk difference in bleeding were calculated using a random-effects model. RESULTS Five hundred and sixty-nine articles were identified initially, and 10 articles (comprising of 908 patients) were included. The incidence of post-TEE bleeding in patients with varices was 0.84% (95% CI, 0.34% to 1.56%). When stratified by indication for TEE, the pooled incidence of bleeding was 0.68% (95% CI, 0.11% to 1.63%) for intraoperative TEE and 1.03% (95% CI, 0.23% to 2.29%) for diagnostic TEE. No cases of esophageal perforation or mortality were reported. Six studies included comparator groups of patients without varices, and the bleeding risk was comparable between patients with and those without varices (risk difference, 0.26%; 95% CI, -0.80% to 1.32%; I2 = 0%; P = .88). Eight studies had moderate or high risk for bias, and the overall level of evidence was low. CONCLUSIONS TEE appears to be associated with low gastrointestinal bleeding incidence in patients with gastroesophageal varices. Nonetheless, results should be treated with caution because of bias and low level of evidence. Large-scale high-quality studies will be required to confirm the safety of TEE in patients with gastroesophageal varices.
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Hsu CY, Parikh ND, Huo TI, Tapper EB. Comparison of Seven Noninvasive Models for Predicting Decompensation and Hospitalization in Patients with Cirrhosis. Dig Dis Sci 2021; 66:4508-4517. [PMID: 33387126 DOI: 10.1007/s10620-020-06763-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/06/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND/AIM Patients with cirrhosis have poor outcomes once decompensation occurs; however, we lack adequate predictors of decompensation. To use a national claim database to compare the predictive accuracy of seven models for decompensation and hospitalization in patients with compensated cirrhosis. METHODS We defined decompensation as ascites, hepatic encephalopathy, hepato-renal syndrome, and variceal bleeding. Patients without decompensation at the time of cirrhosis diagnosis were enrolled from 2001 to 2015. Patients with hepatitis B and/or C were grouped as viral cirrhosis. We compared the predictive accuracy of models with the AUC (area under the curve) and c-statistic. The cumulative incidence of decompensation and incidence risk ratios of hospitalization were calculated with the Fine-Gray competing risk and negative binomial models, respectively. RESULTS A total of 3722 unique patients were enrolled with a mean follow-up time of 524 days. The mean age was 59 (standard deviation 12), and the majority were male (55%) and white (65%). Fifty-three percent of patients had non-viral cirrhosis. Sixteen and 20 percent of patients with non-viral and viral cirrhosis, respectively, developed decompensation (P = 0.589). The FIB-4 model had the highest 3-year AUC (0.73) and overall c-statistic (0.692) in patients with non-viral cirrhosis. The ALBI-FIB-4 model had the best 1-year (AUC = 0.741), 3-year (AUC = 0.754), and overall predictive accuracy (c-statistic = 0.681) in patients with viral cirrhosis. The MELD score had the best predictive power for hospitalization in both non-viral and viral patients. CONCLUSIONS FIB-4-based models provide more accurate prediction for decompensation, and the MELD model has the best predictive ability of hospitalization.
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Affiliation(s)
- Chia-Yang Hsu
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
| | - Neehar D Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Teh-Ia Huo
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Elliot B Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
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Calderón-Parra J, Kestler M, Ramos-Martínez A, Bouza E, Valerio M, de Alarcón A, Luque R, Goenaga MÁ, Echeverría T, Fariñas MC, Pericàs JM, Ojeda-Burgos G, Fernández-Cruz A, Plata A, Vinuesa D, Muñoz P, on behalf of the GAMES Investigators. Clinical Factors Associated with Reinfection versus Relapse in Infective Endocarditis: Prospective Cohort Study. J Clin Med 2021; 10:jcm10040748. [PMID: 33668597 PMCID: PMC7918007 DOI: 10.3390/jcm10040748] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/29/2022] Open
Abstract
We aimed to identify clinical factors associated with recurrent infective endocarditis (IE) episodes. The clinical characteristics of 2816 consecutive patients with definite IE (January 2008–2018) were compared according to the development of a second episode of IE. A total of 2152 out of 2282 (94.3%) patients, who were discharged alive and followed-up for at least the first year, presented a single episode of IE, whereas 130 patients (5.7%) presented a recurrence; 70 cases (53.8%) were due to other microorganisms (reinfection), and 60 cases (46.2%) were due to the same microorganism causing the first episode. Thirty-eight patients (29.2%), whose recurrence was due to the same microorganism, were diagnosed during the first 6 months of follow-up and were considered relapses. Relapses were associated with nosocomial endocarditis (OR: 2.67 (95% CI: 1.37–5.29)), enterococci (OR: 3.01 (95% CI: 1.51–6.01)), persistent bacteremia (OR: 2.37 (95% CI: 1.05–5.36)), and surgical treatment (OR: 0.23 (0.1–0.53)). On the other hand, episodes of reinfection were more common in patients with chronic liver disease (OR: 3.1 (95% CI: 1.65–5.83)) and prosthetic endocarditis (OR: 1.71 (95% CI: 1.04–2.82)). The clinical factors associated with reinfection and relapse in patients with IE appear to be different. A better understanding of these factors would allow the development of more effective therapeutic strategies.
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Affiliation(s)
- Jorge Calderón-Parra
- Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro- Majadahonda (IDIPHSA), 28222 Madrid, Spain; (J.C.-P.); (A.F.-C.)
| | - Martha Kestler
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.K.); (E.B.); (M.V.); (P.M.)
| | - Antonio Ramos-Martínez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro- Majadahonda (IDIPHSA), 28222 Madrid, Spain; (J.C.-P.); (A.F.-C.)
- Correspondence: ; Tel.: +34-638-211-120; Fax: +34-91191-6807
| | - Emilio Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.K.); (E.B.); (M.V.); (P.M.)
- Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Maricela Valerio
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.K.); (E.B.); (M.V.); (P.M.)
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infectious Diseases Research Group, University of Seville/CSIC/University Virgen del Rocío and Virgen Macarena (IBIS), 41013 Sevilla, Spain; (A.d.A.); (R.L.)
| | - Rafael Luque
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infectious Diseases Research Group, University of Seville/CSIC/University Virgen del Rocío and Virgen Macarena (IBIS), 41013 Sevilla, Spain; (A.d.A.); (R.L.)
| | - Miguel Ángel Goenaga
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, 20010 San Sebastián, Spain;
| | - Tomás Echeverría
- Servicio de Cardiología, Hospital Donosti, 20010 San Sebastián, Spain;
| | - Mª Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, 39008 Santander, Spain;
| | - Juan M. Pericàs
- Infectious Disease Department, Hospital Clínic de Barcelona (IDIBAPS), 08036 Barcelona, Spain;
| | - Guillermo Ojeda-Burgos
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain;
| | - Ana Fernández-Cruz
- Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro- Majadahonda (IDIPHSA), 28222 Madrid, Spain; (J.C.-P.); (A.F.-C.)
| | - Antonio Plata
- Servicio de Enfermedades Infecciosas, Hospital Regional de Málaga, 29010 Málaga, Spain;
| | - David Vinuesa
- Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital Clínico San Cecilio, 18016 Granada, Spain;
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.K.); (E.B.); (M.V.); (P.M.)
- Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Xiang Y, Wang X, Mei XC, Han Y, Kong DR. Decompensated cirrhosis with valve perforation due to infective endocarditis: A case report. Shijie Huaren Xiaohua Zazhi 2020; 28:1048-1052. [DOI: 10.11569/wcjd.v28.i20.1048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Bacterial infection is one of the main reasons for increased mortality of patients with cirrhosis, and patients with decompensated cirrhosis is more likely to be infected than those with compensated cirrhosis. The most common and life-threatening infection in cirrhosis is spontaneous bacterial peritonitis, followed by urinary tract infections, pneumonia, endocarditis, and skin and soft tissue infections. However, except spontaneous bacterial peritonitis, the incidence of other infections is low and little is known on them.
CASE SUMMARY This paper reports a patient with recurrent spontaneous peritonitis in the decompensated stage of liver cirrhosis at our hospital, who eventually developed infective endocarditis (IE) that was cured by surgery.
CONCLUSION The prognosis of cirrhosis complicated with IE is poor. Early detection and timely intervention can improve survival rate. In cirrhotic patients with recurrent bacterial peritonitis and unexplained chest tightness, dyspnea, or unexplained recurrent fever, the possibility of IE should be considered.
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Affiliation(s)
- Yi Xiang
- Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University, Hefei 237000, Anhui Province, China
| | - Xi Wang
- Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University, Hefei 237000, Anhui Province, China
| | - Xue-Can Mei
- Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University, Hefei 237000, Anhui Province, China
| | - Yi Han
- Department of Gastroenterology, the Fuyang Hospital Affiliated to Anhui Medical University, Fuyang 236000, Anhui Province, China
| | - De-Run Kong
- Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University, Hefei 237000, Anhui Province, China
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Hung TH, Tsai CC, Lee HF. Effects of poor hepatic reserve in cirrhotic patients with bacterial infections: A population-based study. Tzu Chi Med J 2020; 32:47-52. [PMID: 32110520 PMCID: PMC7015002 DOI: 10.4103/tcmj.tcmj_142_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/18/2018] [Accepted: 10/03/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Ascites, hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, and esophageal variceal bleeding are major complications associated with cirrhosis. The presence of these complications indicates poor hepatic reserve. This study aimed to identify the effects of poor hepatic reserve on mortality in cirrhotic patients with bacterial infections. PATIENTS AND METHODS The Taiwan National Health Insurance Database was used to identify 43,042 cirrhotic patients with bacterial infections hospitalized between January 1, 2010, and December 31, 2013, after propensity score matching analysis. Of these, 21,521 cirrhotic patients had major cirrhotic-related complications and were considered to have poor hepatic reserve. RESULTS Mortality rates at 30 and 90 days were 24.2% and 39.5% in the poor hepatic reserve group and 12.8% and 21.7% in the good hepatic reserve group, respectively (P < 0.001 for each group). The cirrhotic patients with poor hepatic reserve (hazard ratio [HR], 2.10; 95% confidence interval [CI] = 2.03-2.18; P < 0.001) had significantly increased mortality at 90 days. The mortality HRs in patients with one, two, and three or more complications compared to patients without complications were 1.92 (95% CI = 1.85-1.99, P < 0.001), 2.61 (95% CI = 2.47-2.77, P < 0.001), and 3.81 (95% CI = 3.18-4.57, P < 0.001), respectively. CONCLUSION In cirrhotic patients with bacterial infections, poor hepatic reserve is associated with a poor prognosis. The presence of three or more cirrhotic-related complications increases mortality almost four folds.
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Affiliation(s)
- Tsung-Hsing Hung
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chih-Chun Tsai
- Department of Mathematics, Tamkang University, New Taipei, Taiwan
| | - Hsing-Feng Lee
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Abstract
Bacterial infections are common in the case of cirrhosis and represent a major cause of morbidity and mortality. The most frequent infections are spontaneous bacterial peritonitis, urinary tract infection, and pneumonia, but few data on infectious endocarditis are available. Infectious endocarditis is a rare event, and diagnosis can be made at all stages of Child-Pugh classification. In the case of cirrhosis, the clinical features and bacterial ecology are similar to that of the general population (two males/one female, preferential location on the aortic and mitral valves, history of heart disease, majority of Gram-positive bacteria), but in-hospital mortality is higher. The Child-Pugh score and a history of decompensation have been identified as independent predictive factors for in-hospital mortality and a Child-Pugh score more than C10 was associated with a higher risk of death. Less frequent use of aminoglycosides, rifampin, and cardiac surgery has been described in cirrhotic patients, probably because of potential toxicity. Nevertheless, as they are a cornerstone of therapy, prospective studies on the impact of these therapeutics are warranted to improve outcome in this population of patients.
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Allaire M, Cadranel JFD, Bureau C, Zerkly S, Thévenot T, Garioud A, Cacoub P, Macaigne G, Alric L, Jouannaud V, Lison H, Chagneau-Derrode C, Pariente A, Pélaquier A, Bourlière M, Causse X, Nousbaum JB, Dumortier J, Louvet A, Rosa-Hézode I, Ganne-Carrié N, Chentouh R, Sfaxi A, Gournay J, Blasco-Perrin H, Antonini T, Spahr L, Bronowicki JP, Silvain C, Di Martino V, Grange JD, Denis J, Dupont K, Iaria P, Ollivier-Hourmand I, Dao T. Severe liver failure rather than cirrhosis is associated with mortality in patients with infectious endocarditis: a retrospective case-control study. Eur J Gastroenterol Hepatol 2018; 30:1216-1223. [PMID: 29727379 DOI: 10.1097/meg.0000000000001155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Data on infectious endocarditis (IE) in patients with liver cirrhosis (LC) are sparse. We aimed to describe the characteristics and predictors of mortality from IE in patients with LC. PATIENTS AND METHODS Overall, 101 patients with LC and 101 controls with IE matched for sex, age, date of IE, and diabetes were retrospectively selected in 23 liver units between 2000 and 2013. RESULTS Mean age was 60.8±10.5 and 60.6±11.5 years in LC and controls, respectively. Causes of cirrhosis (Child-Pugh A/B/C: 10.4%/41.7%/47.9%, MELD score: 17±7.8) were excess alcohol intake (79.6%), viral hepatitis (17.3%), and metabolic syndrome (14.3%). Previous history of cardiopathy was found in 24.8% of LC (prosthetic valve 8.9%) and 37.6% of controls (P=0.07). The most frequent bacteria involved were gram-positive cocci. LC had significantly fewer aminoglycosides (P=0.0007), rifamycin (P=0.03), and valve surgery (P=0.02) than controls. The proportion of patients who died following cardiac surgery was similar between the two groups (9.7% for LC vs. 8.7% for controls, P=1). In-hospital mortality for Child-Pugh C patients was significantly higher than controls (61.4 vs. 23%, P<0.001), but not for Child-Pugh A (33.3%) or B patients (25.0%). A Child-Pugh score of above C10 was the best predictor of in-hospital mortality. In LC, Child-Pugh score (odds ratio=1.5; 95% confidence interval: 1.2-2.0; P=0.002) and history of decompensation (odds ratio=3.1; 95% confidence interval: 1.1-9.0; P=0.003) were independent predictive factors for in-hospital mortality. CONCLUSION Severe liver failure but not cirrhosis is the strongest predictive factor of mortality related to IE in LC. Use of aminosides and rifamycin should be reassessed in LC, and cardiac surgery should be considered for selected patients.
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Affiliation(s)
- Manon Allaire
- Department of Hepato-Gastroenterology, CHU Côte de Nacre, Caen
- Departments of Inserm-U1149, CRI
| | | | | | | | | | - Armand Garioud
- Hepato-Gastroenterology, CHU Tenon
- Departments of Hepato-Gastroenterology
| | - Patrice Cacoub
- Internal Medicine, CHU Pitie[Combining Acute Accent]-Salpétrie[Combining Grave Accent]re, Paris
| | | | | | - Vincent Jouannaud
- Department of Hepato-Gastroenterology, Montfermeil Hospital, Montfermeil
| | | | | | | | - Agnès Pélaquier
- Department of Hepato-Gastroenterology, Montélimar Hospital, Montélimar
| | - Marc Bourlière
- Department of Hepato-Gastroenterology, Saint Joseph Hospital, Marseille
| | | | | | - Jerôme Dumortier
- Department of Hepato-Gastroenterology, CHU Hospices-Civils, Lyon
| | | | | | | | - Ryme Chentouh
- Internal Medicine, CHU Pitie[Combining Acute Accent]-Salpétrie[Combining Grave Accent]re, Paris
| | | | | | | | | | - Laurent Spahr
- Department of Hepato-Gastroenterology, Universitary Hospital, Geneva, Switzerland
| | | | | | | | | | - Jacques Denis
- Department of Hepato-Gastroenterology, Corbeil-Essonnes Hospital, Corbeil-Essonnes, France
| | | | | | | | - Thong Dao
- Department of Hepato-Gastroenterology, CHU Côte de Nacre, Caen
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Dietary Manganese Promotes Staphylococcal Infection of the Heart. Cell Host Microbe 2017; 22:531-542.e8. [PMID: 28943329 DOI: 10.1016/j.chom.2017.08.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/29/2017] [Accepted: 08/17/2017] [Indexed: 01/25/2023]
Abstract
Diet, and specifically dietary metals, can modify the risk of infection. However, the mechanisms by which manganese (Mn), a common dietary supplement, alters infection remain unexplored. We report that dietary Mn levels dictate the outcome of systemic infections caused by Staphylococcus aureus, a leading cause of bacterial endocarditis. Mice fed a high Mn diet display alterations in Mn levels and localization within infected tissues, and S. aureus virulence and infection of the heart are enhanced. Although the canonical mammalian Mn-sequestering protein calprotectin surrounds staphylococcal heart abscesses, calprotectin is not released into the abscess nidus and does not limit Mn in this organ. Consequently, excess Mn is bioavailable to S. aureus in the heart. Bioavailable Mn is utilized by S. aureus to detoxify reactive oxygen species and protect against neutrophil killing, enhancing fitness within the heart. Therefore, a single dietary modification overwhelms vital host antimicrobial strategies, leading to fatal staphylococcal infection.
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15
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Pettersson GB, Coselli JS, Pettersson GB, Coselli JS, Hussain ST, Griffin B, Blackstone EH, Gordon SM, LeMaire SA, Woc-Colburn LE. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: Executive summary. J Thorac Cardiovasc Surg 2017; 153:1241-1258.e29. [PMID: 28365016 DOI: 10.1016/j.jtcvs.2016.09.093] [Citation(s) in RCA: 282] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/12/2016] [Accepted: 09/16/2016] [Indexed: 12/23/2022]
Affiliation(s)
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | | | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | - Syed T Hussain
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
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16
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Bartoletti M, Giannella M, Lewis RE, Viale P. Bloodstream infections in patients with liver cirrhosis. Virulence 2016; 7:309-19. [PMID: 26864729 DOI: 10.1080/21505594.2016.1141162] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Bloodstream infections are a serious complication in patients with liver cirrhosis. Dysregulated intestinal bacterial translocation is the predominant pathophysiological mechanism of infections in this setting. For this reason enteric Gram-negative bacteria are commonly encountered as the first etiological cause of infection. However, through the years, the improvement in the management of cirrhosis, the recourse to invasive procedures and the global spread of multidrug resistant pathogens have importantly changed the current epidemiology. Bloodstream infections in cirrhotic patients are characterized by high mortality rate and complications including metastatic infections, infective endocarditis, and endotipsitis (or transjugular intrahepatic portosystemic shunt-related infection). For this reason early identification of patients at risk for mortality and appropriated therapeutic management is mandatory. Liver cirrhosis can significantly change the pharmacokinetic behavior of antimicrobials. In fact hypoproteinaemia, ascitis and third space expansion and impairment of renal function can be translated in an unpredictable drug exposure.
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Affiliation(s)
- Michele Bartoletti
- a Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna , Bologna , Italy
| | - Maddalena Giannella
- a Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna , Bologna , Italy
| | - Russell Edward Lewis
- a Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna , Bologna , Italy
| | - Pierluigi Viale
- a Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna , Bologna , Italy
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17
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Seminari E, De Silvestri A, Ravasio V, Ludovisi S, Utili R, Petrosillo N, Castelli F, Bassetti M, Barbaro F, Grossi P, Barzaghi N, Rizzi M, Minoli L. Infective endocarditis in patients with hepatic diseases. Eur J Clin Microbiol Infect Dis 2015; 35:279-84. [PMID: 26690071 DOI: 10.1007/s10096-015-2541-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/29/2015] [Indexed: 01/04/2023]
Abstract
Few data have been published regarding the epidemiology and outcome of infective endocarditis (IE) in patients with chronic hepatic disease (CHD). A retrospective analysis of the Studio Endocarditi Italiano (SEI) database was performed to evaluate the epidemiology and outcome of CHD+ patients compared with CHD- patients. The diagnosis of IE was defined in accordance with the modified Duke criteria. Echocardiography, diagnosis, and treatment procedures were in accordance with current clinical practice. Among the 1722 observed episodes of IE, 300 (17.4 %) occurred in CHD+ patients. The cause of CHD mainly consisted of chronic viral infection. Staphylococcus aureus was the most common bacterial species in CHD+ patients; the frequency of other bacterial species (S. epidermidis, streptococci, and enterococci) were comparable among the two groups. The percentage of patients undergoing surgery for IE was 38.9 in CHD+ patients versus 43.7 in CHD- patients (p = 0.06). Complications were more common among CHD+ patients (77 % versus 65.3 %, p < 0.001); embolization (43.3 % versus 26.1 %, p < 0.001) and congestive heart failure (42 % versus 34.1 %, p = 0.01) were more frequent among CHD+ patients. Mortality was comparable (12.5 % in CHD- and 15 % in CHD+ patients). At multivariable analysis, factors associated with hospital-associated mortality were having an infection sustained by S. aureus, a prosthetic valve, diabetes and a neoplasia, and CHD. Being an intravenous drug user (IVDU) was a protective factor and was associated with a reduced death risk. CHD is a factor worsening the prognosis in patients with IE, in particular in patients for whom cardiac surgery was required.
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Affiliation(s)
- E Seminari
- Clinica di Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - A De Silvestri
- Direzione Scientifica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - V Ravasio
- USC Malattie Infettive, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - S Ludovisi
- Clinica di Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - R Utili
- Internal Medicine Section, University of Naples S.U.N., Napoli, Italy
| | - N Petrosillo
- 2nd Division of Infectious Diseases, National Institute for Infectious Diseases "Spallanzani", Roma, Italy
| | - F Castelli
- Clinica di Malattie Infettive e Tropicali, Università degli Studi di Brescia, Brescia, Italy
| | - M Bassetti
- Clinica di Malattie Infettive, AOU Santa Maria della Misericordia, Udine, Italy
| | - F Barbaro
- UO Malattie Infettive e Tropicali, Azienda Ospedaliera di Padova, Padova, Italy
| | - P Grossi
- Clinica di Malattie Infettive e Tropicali, Università degli Studi dell'Insubria, Varese, Italy
| | - N Barzaghi
- UO Terapia Intensiva, Cardiochirurgica, ASO S. Croce e Carle, Cuneo, Italy
| | - M Rizzi
- USC Malattie Infettive, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - L Minoli
- Clinica di Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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18
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Ruiz-Morales J, Ivanova-Georgieva R, Fernández-Hidalgo N, García-Cabrera E, Miró JM, Muñoz P, Almirante B, Plata-Ciézar A, González-Ramallo V, Gálvez-Acebal J, Fariñas MC, Bravo-Ferrer JM, Goenaga-Sánchez MA, Hidalgo-Tenorio C, Goikoetxea-Agirre J, de Alarcón-González A. Left-sided infective endocarditis in patients with liver cirrhosis. J Infect 2015; 71:627-641. [PMID: 26408206 DOI: 10.1016/j.jinf.2015.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/05/2015] [Accepted: 09/07/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery. METHODS Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals. RESULTS A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery. CONCLUSIONS Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.
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Affiliation(s)
- J Ruiz-Morales
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
| | - R Ivanova-Georgieva
- Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
| | - N Fernández-Hidalgo
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - E García-Cabrera
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Jose M Miró
- Hospital Clinic - IDIBAPS, Servicio de Enfermedades Infecciosas y Microbiología, Universidad de Barcelona, Barcelona, Spain.
| | - P Muñoz
- Servicio de Microbiología y Enfermedades infecciosas, H. Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
| | - B Almirante
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - A Plata-Ciézar
- UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital General Universitario, Málaga, Spain.
| | - V González-Ramallo
- Unidad de Hospitalización a Domicilio, H. Universitario Gregorio Marañón, Madrid, Spain.
| | - J Gálvez-Acebal
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - M C Fariñas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
| | - J M Bravo-Ferrer
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario Juan Canalejo, A Coruña, Spain.
| | - M A Goenaga-Sánchez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián, Spain.
| | - C Hidalgo-Tenorio
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - J Goikoetxea-Agirre
- Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Bilbao, Spain.
| | - A de Alarcón-González
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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19
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Rodríguez Martínez S, Talaván Serna J, Silvestre FJ. [Dental management in patients with cirrhosis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 39:224-32. [PMID: 26541210 DOI: 10.1016/j.gastrohep.2015.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 07/14/2015] [Accepted: 07/27/2015] [Indexed: 01/03/2023]
Abstract
The present article makes a brief review about dental management of the patients with cirrhosis. It focus on problems related with infections, haemorrhagic events and treatment with drugs of common use in odontology.
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Affiliation(s)
| | - Julio Talaván Serna
- Servicio de Anestesiología y Reanimación, Hospital General d́Ontinyent, Valencia, España
| | - Francisco-Javier Silvestre
- Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España
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20
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Epidemiological characteristics of bloodstream infections in patients with different degrees of liver disease. Infection 2015; 43:561-7. [PMID: 25976737 DOI: 10.1007/s15010-015-0794-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 05/06/2015] [Indexed: 12/20/2022]
Abstract
Observational retrospective study to evaluate the etiology, the outcome and the risk factors of bloodstream infections (BSIs) in patients with liver disease. One hundred and forty-eight BSIs were diagnosed (infection rate: 0.60 per 100 days of hospital stay), 62 BSIs (41.9 %) were associated with Gram-positive bacteria (infection rate: 0.25 per 100 days of hospital stay) and 80 (54.4 %) with Gram-negative bacteria (infection rate: 0.32 per 100 days of hospital stay). Admission-associated mortality was higher in patients with BSI than in those without BSI (20.6 versus 5.0 %, p < 0.001). Patients with cirrhosis had an increased risk to develop a BSI compared with patients with chronic hepatitis, specifically for Gram-positive (and Staphylococcus spp)-related BSI.
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21
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Bruns T, Zimmermann HW, Stallmach A. Risk factors and outcome of bacterial infections in cirrhosis. World J Gastroenterol 2014; 20:2542-2554. [PMID: 24627590 PMCID: PMC3949263 DOI: 10.3748/wjg.v20.i10.2542] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/05/2014] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Viable and non-viable pathological bacterial translocation promote a self-perpetuating circle of dysfunctional immune activation and systemic inflammation facilitating infections and organ failure in advanced cirrhosis. Bacterial infections and sepsis are now recognized as a distinct stage in the natural progression of chronic liver disease as they accelerate organ failure and contribute to the high mortality observed in decompensated cirrhosis. The increasing knowledge of structural, immunological and hemodynamic pathophysiology in advanced cirrhosis has not yet translated into significantly improved outcomes of bacterial infections over the last decades. Therefore, early identification of patients at the highest risk for developing infections and infection-related complications is required to tailor the currently available measures of surveillance, prophylaxis and therapy to the patients in need in order to improve the detrimental outcome of bacterial infections in cirrhosis.
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