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Bacterial Infection-Related Morbidity and Mortality in Cirrhosis

Christou, Leonidas, M.D.1; Pappas, Georgios, M.D.2; Falagas, Matthew E., M.D.3,4

American Journal of Gastroenterology: July 2007 - Volume 102 - Issue 7 - p 1510–1517

OBJECTIVES Bacterial infections are acknowledged causes of morbidity and mortality in cirrhotic patients; yet, apart from spontaneous bacterial peritonitis, other infection issues have been understudied. We evaluated the existing medical data on infectious risks and related preventive and treatment data for cirrhotic patients.

METHODS Medical literature search through MEDLINE, using a variety of keywords focused on: (a) immunodeficiency parameters of cirrhosis and attempts at therapeutic reversal, (b) relative incidence of various focal infections and implications for prevention, and (c) specific pathogens posing a risk in cirrhosis and availability of preventive strategies.

RESULTS Immunodeficiency in cirrhosis is multifactorial and might not be reversed by isolated interventions. Epidemiologic data on the incidence of specific infections and risk factors are scarce, only Child-Pugh stage C being a common denominator. A variety of common, such as Staphylococcus aureus, Streptococcus pneumoniae, and Mycobacterium tuberculosis, as well as uncommon pathogens possess significant risks in cirrhosis. Certain aspects of these risks remain though unrecognized.

CONCLUSIONS To better understand the overall burden of bacterial infections on cirrhotic patients' survival, more data on preventive efficacy of pneumococcal vaccination, on the overall burden of tuberculosis, and the relative incidence of specific infections as endocarditis are warranted.

1Division of Internal Medicine of the Medical School at the University of Ioannina, Ioannina, Greece; 2Institute of Continuing Medical Education of Ioannina (ICMEI), Ioannina, Greece; 3Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; and 4Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts

Reprint requests and correspondence: Dr. Georgios Pappas, Institute for Continuing Medical Education of Ioannina, Har. Trikoupi 10, Ioannina, 45333, Greece.

Received September 13, 2006; accepted March 13, 2007.

© The American College of Gastroenterology 2007. All Rights Reserved.
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