Gastroenterology and Hepatology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.
Liver Transpl. 2019 Nov;25(11):1700-1709. doi: 10.1002/lt.25621. Epub 2019 Sep 18.
Bacterial infections are more frequent and severe in patients with advanced liver disease and, therefore, in liver transplant candidates. The increased risk of infection in these patients parallels the severity of the immune dysfunction associated with cirrhosis, which is related to systemic inflammation and progressive immunodeficiency. Other factors contribute to this risk, such as genetic polymorphisms, proton pump inhibitor overuse, the numerous invasive procedures and hospitalizations these patients go through, or the immunosuppressive effects of malnutrition or alcohol abuse. Bacterial infections have a great impact on disease progression and significantly increase mortality rates before and after liver transplantation. Mechanisms leading to organ failure in sepsis are associated not only with the hemodynamic derangement but also with an excessive inflammatory response triggered by infection. Furthermore, prophylactic and empirical antibiotic treatment strategies in patients with cirrhosis are being modified according to the growing prevalence of multidrug-resistant bacteria in the past decade. Also, new criteria have been introduced for the diagnosis of sepsis and septic shock. These new definitions have been validated in patients with cirrhosis and show a better accuracy to predict in-hospital mortality than previous criteria based on systemic inflammatory response syndrome. Accurate prophylaxis and early identification and treatment of bacterial infections are key to reducing the burden of sepsis in patients with cirrhosis awaiting liver transplantation.
细菌感染在晚期肝病患者中更为频繁和严重，因此也是肝移植候选者中的一个问题。这些患者感染风险的增加与肝硬化相关的免疫功能障碍的严重程度平行，这与全身性炎症和进行性免疫缺陷有关。其他因素也会增加这种风险，例如遗传多态性、质子泵抑制剂的过度使用、这些患者经历的大量侵入性操作和住院治疗，或营养不良或酗酒的免疫抑制作用。细菌感染对疾病进展有重大影响，并大大增加肝移植前后的死亡率。脓毒症导致器官衰竭的机制不仅与血液动力学紊乱有关，还与感染引发的过度炎症反应有关。此外，根据过去十年中多药耐药菌的流行情况，正在对肝硬化患者的预防性和经验性抗生素治疗策略进行修改。此外，还引入了用于诊断脓毒症和脓毒性休克的新标准。这些新定义已在肝硬化患者中得到验证，与以前基于全身炎症反应综合征的标准相比，它们具有更高的准确性来预测住院死亡率。准确的预防、早期发现和治疗细菌感染是降低等待肝移植的肝硬化患者脓毒症负担的关键。
