Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom.
Institute of Liver Studies, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
Semin Liver Dis. 2022 May;42(2):173-187. doi: 10.1055/a-1765-0056. Epub 2022 Feb 7.
The World Health Organization describes antimicrobial resistance as one of the biggest threats to global health, food security, and development with indiscriminate use of antimicrobials globally driving the emergence of multidrug-resistant bacteria, resistant to 60% of antimicrobials in some countries. Infections with multidrug-resistant organisms (MDROs) have increased in recent decades in patients with cirrhosis, who are frequently prescribed antibiotics, regularly undergo invasive procedures such as large volume paracentesis, and have recurrent hospitalizations, posing a particular risk in this already immunocompromised cohort of patients. In this review, we explore mechanisms underlying this vulnerability to MDRO infection; the effect of bacterial infections on disease course in cirrhosis; prevalence of MDROs in patients with cirrhosis; outcomes following MDRO infection; fungal infections; antibiotics and their efficacy; and management of MDRO infections in terms of detection, antimicrobial and nonantimicrobial treatments, prophylaxis, antibiotic stewardship, the gut microbiome, and technological interventions.
世界卫生组织将抗菌药物耐药性描述为对全球健康、食品安全和发展的最大威胁之一，全球对抗菌药物的滥用推动了多药耐药菌的出现，一些国家有 60%的抗菌药物耐药。在最近几十年中，肝硬化患者中耐多药生物体（MDRO）感染有所增加，这些患者经常开处方使用抗生素，经常进行大容量腹腔穿刺等侵入性操作，并且反复住院，这对这群已经免疫功能低下的患者构成了特殊风险。在这篇综述中，我们探讨了导致这种 MDRO 感染易感性的机制；细菌感染对肝硬化病程的影响；肝硬化患者中 MDRO 的流行情况；MDRO 感染后的结局；真菌感染；抗生素及其疗效；以及 MDRO 感染的检测、抗菌和非抗菌治疗、预防、抗生素管理、肠道微生物组和技术干预等方面的管理。
