Management of infections in patients with cirrhosis in the context of increasing therapeutic resistance: A systematic review

Publication date: Available online 6 November 2019Source: Clinics and Research in Hepatology and GastroenterologyAuthor(s): Manon Allaire, Jean-François Cadranel, Thi Thu Nga Nguyen, Armand Garioud, Honore Zougmore, Ratmony Heng, Claire Perignon, Isabelle Ollivier-Hourmand, Thông DaoSummaryPatients with cirrhosis are prone to develop bacterial infections, which consist in one of the major precursors of Acute-on-Chronic Liver Failure (ACLF) and are responsible for a high mortality rate. In recent years, the management of bacterial infections in patients with cirrhosis has become increasingly complicated due to a change in bacterial ecology associated with a higher rate of cocci gram positive bacteria in Europe and America along with the emergence of a multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacteria leading to a decrease in the efficacy of empirical strategies based on the administration of third-generation cephalosporins. MDR and XDR now account for about 40% of the infections worldwide, and up to 70% in India. Among them, the most common ones are extended-spectrum beta-lactamase producing (ESBL-P) bacteria, carbapenem-resistant enterobacteriaceae (CRE), Methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE). An early diagnosis associated to an empirical antibiotic adapted to the site of infection and potential bacterial resistance is now crucial in order to improve the chances of survival and contain...
Source: Clinics and Research in Hepatology and Gastroenterology - Category: Gastroenterology Source Type: research

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