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J Hepatol. 2014 Jun;60(6):1310-24. doi: 10.1016/j.jhep.2014.01.024. Epub 2014 Feb 12.

Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013.

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Liver Failure Group, UCL Institute for Liver and Digestive Health, Royal Free Hospital, UK.
Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
Department of Gastroenterology, UVCM, Inselspital, 3010 Bern, Switzerland.
Department of Medicine, University of California San Diego, La Jolla, CA, USA.
INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, UMRS 773, Université Paris-Diderot Paris, Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.
Unit of Hepatic Emergencies and Liver Transplantation, Department of Medicine, University of Padova, Italy.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Austria.
Department of Gastroenterology and Hepato-Pancreatology, Erasme Hospital, Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium.
Department of Medical and Surgical Sciences, University of Bologna, Italy.
Department of Microbiology, Hospital Universitario Ramón y Cajal and Intituto Ramon y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
Gastroenterology Service, University Hospital Ramon y Cajal, Madrid, Spain.
Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
Medical Intensive Care Unit, University Hospital Gasthuisberg, Leuven, Belgium.
Department of Microbiology, Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain.
Institute of Liver Studies and Critical Care, Kings College London, Kings College Hospital, UK.
Department of Clinical Medicine, Miguel Hernández University, Alicante, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
Charles Caravati Professor of Medicine, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA.
The Royal Free Shelia Sherlock Liver Centre and University Department of Surgery, University College London and Royal Free Hospital, UK.
Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain. Electronic address:


Bacterial infections are very common and represent one of the most important reasons of progression of liver failure, development of liver-related complications, and mortality in patients with cirrhosis. In fact, bacterial infections may be a triggering factor for the occurrence of gastrointestinal bleeding, hypervolemic hyponatremia, hepatic encephalopathy, kidney failure, and development of acute-on-chronic liver failure. Moreover, infections are a very common cause of repeated hospitalizations, impaired health-related quality of life, and increased healthcare costs in cirrhosis. Bacterial infections develop as a consequence of immune dysfunction that occurs progressively during the course of cirrhosis. In a significant proportion of patients, infections are caused by gram-negative bacteria from intestinal origin, yet gram-positive bacteria are a frequent cause of infection, particularly in hospitalized patients. In recent years, infections caused by multidrug-resistant bacteria are becoming an important clinical problem in many countries. The reduction of the negative clinical impact of infections in patients with cirrhosis may be achieved by a combination of prophylactic measures, such as administration of antibiotics, to reduce the occurrence of infections in high-risk groups together with early identification and management of infection once it has developed. Investigation on the mechanisms of altered gut microflora, translocation of bacteria, and immune dysfunction may help develop more effective and safe methods of prevention compared to those that are currently available. Moreover, research on biomarkers of early infection may be useful in early diagnosis and treatment of infections. The current manuscript reports an in-depth review and a position statement on bacterial infections in cirrhosis.


Bacterial infection; Cirrhosis; Diagnosis; Multiresistant bacteria

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