Liver Unit, IMDiM, Hospital Clínic, Universidad de Barcelona, IDIBAPS and CIBERehd, Barcelona, Spain.
J Hepatol. 2012;56 Suppl 1:S1-12. doi: 10.1016/S0168-8278(12)60002-6.
Bacterial infections are very frequent in advanced cirrhosis and become the first cause of death of these patients. Despite numerous experimental data and significant advances in the understanding of the pathogenesis of sepsis in cirrhosis, the outcome remains poor. Classical diagnostic parameters such as C-reactive protein and SIRS criteria have less diagnostic capacity in the cirrhotic population, often delaying the diagnosis and the management of bacterial infection. Prompt and appropriate empirical antibiotic treatment of infection and early resuscitation of patients with severe sepsis or septic shock are essential in determining patient's outcome. A strategy of careful restriction of prophylactic antibiotics to the high-risk populations could reduce the spread of multidrug resistant bacteria. This review is focused on the currently recommended diagnostic, therapeutic and prophylactic strategies for bacterial infections in the cirrhotic population.
细菌感染在晚期肝硬化中非常常见，成为这些患者死亡的首要原因。尽管有大量的实验数据和对肝硬化患者脓毒症发病机制的深入了解，但预后仍然很差。在肝硬化患者中，经典的诊断参数（如 C 反应蛋白和 SIRS 标准）的诊断能力降低，这常常导致感染的诊断和治疗延迟。及时和适当的经验性抗生素治疗感染以及对严重脓毒症或感染性休克患者的早期复苏对于确定患者的预后至关重要。对高危人群预防性使用抗生素的策略应谨慎限制，以减少多药耐药菌的传播。这篇综述重点介绍了目前推荐的肝硬化患者细菌感染的诊断、治疗和预防策略。
