Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy.
Expert Rev Anti Infect Ther. 2020 Mar;18(3):191-202. doi: 10.1080/14787210.2020.1725473. Epub 2020 Feb 13.
: Liver cirrhosis is a frequent condition caused by different etiologies. Bacterial and fungal infections are common complications, representing an independent prognostic stage in patients with cirrhosis, dramatically worsening their clinical outcomes.: The present review article addresses manifold points and to this purpose an inductive literature search of MEDLINE database through PubMed was performed. First, it provides an overview on the mechanisms underlying immune disfunctions in patients with cirrhosis, who are prone to develop infections being at higher risk than the general population. Second, commonest types of bacterial and fungal infections in patients with advanced liver disease are described, focusing on their deleterious impact as decompensating events. Third, the rise of multidrug-resistant (MDR) bacteria and fungi as causative agents of infection in cirrhotic subjects is illustrated. Eventually, the most promising novel therapeutic options against MDR pathogens and fungi are reviewed.: The management of bacterial and fungal infections in patients with cirrhosis is difficult, due to the frequent co-existence of renal impairment, low platelet count and other conditions that limit the antimicrobial choice. New antibacterial and antifungal compounds may overcome this issue by providing a better tolerability profile, along with equal or superior efficacy compared with older drugs.
肝硬化是一种由不同病因引起的常见疾病。细菌和真菌感染是常见的并发症，代表着肝硬化患者的一个独立预后阶段，显著恶化了他们的临床结局。
本文主要讨论了多方面的问题，为此，通过 PubMed 在 MEDLINE 数据库中进行了归纳性文献检索。首先，它概述了肝硬化患者免疫功能障碍的机制，这些患者易发生感染，比普通人群面临更高的风险。其次，描述了晚期肝病患者中常见的细菌和真菌感染类型，重点关注它们作为失代偿事件的有害影响。第三，阐明了多药耐药（MDR）细菌和真菌作为肝硬化患者感染病原体的上升趋势。最后，综述了针对 MDR 病原体和真菌的最有前途的新型治疗选择。
肝硬化患者的细菌和真菌感染的治疗具有挑战性，因为常常存在肾功能损害、血小板计数低和其他限制抗菌药物选择的情况。新型抗菌和抗真菌药物可能通过提供更好的耐受性和与旧药物相当或更好的疗效来克服这一问题。
