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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 4
Apr.  2021
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Article Contents

Diagnosis and treatment of abdominal infection in patients with liver cirrhosis: Advances and challenges

DOI: 10.3969/j.issn.1001-5256.2021.04.003
  • Received Date: 2020-12-25
  • Accepted Date: 2021-01-04
  • Published Date: 2021-04-20
  • Infection is the most common complication in patients with end-stage liver disease, among which abdominal infection is the most common type. There is a low positive rate of ascitic fluid culture, and abdominal infection is mainly diagnosed based on multinucleated cell count in ascites and is mainly treated by empirical antimicrobial therapy. The diagnostic criteria for abdominal infection have limited guiding significance in clinical practice, and currently there are still no new diagnostic markers that can be used in clinical practice. For the pathogenic diagnosis of abdominal infection, metagenomic next-generation sequencing is a new technique for rapid identification of pathogens of abdominal infection or overlap infection in liver cirrhosis. In terms of treatment, Chinese guidelines on the management of ascites in cirrhosis emphasize antimicrobial therapy and give no explicit recommendation for the dose of human serum albumin infusion. There are still great challenges in the diagnosis and treatment of abdominal infection in cirrhotic patients, and more studies are needed in the future to answer relevant questions and better guide clinical practice, including the optimization of the diagnosis, prevention, and treatment of abdominal infection.

     

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  • [1]
    PIANO S, BROCCA A, MARESO S, et al. Infections complicating cirrhosis[J]. Liver Int, 2018, 38(Suppl 1): 126-133. DOI: 10.1111/liv.13645.
    [2]
    SIMONETTO DA, PICCOLO SERAFIM L, GALLO DE MORAES A, et al. Management of sepsis in patients with cirrhosis: Current evidence and practical approach[J]. Hepatology, 2019, 70(1): 418-428. DOI: 10.1002/hep.30412.
    [3]
    MOREAU R, JALAN R, GINES P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis[J]. Gastroenterology, 2013, 144(7): 1426-1437.e1-e9. DOI: 10.1053/j.gastro.2013.02.042.
    [4]
    ARVANITI V, D'AMICO G, FEDE G, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis[J]. Gastroenterology, 2010, 139(4): 1246-1256.e1-e5. DOI: 10.1053/j.gastro.2010.06.019.
    [5]
    PIANO S, SINGH V, CARACENI P, et al. Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide[J]. Gastroenterology, 2019, 156(5): 1368-1380.e10. DOI: 10.1053/j.gastro.2018.12.005.
    [6]
    RUNYON BA, SQUIER S, BORZIO M. Translocation of gut bacteria in rats with cirrhosis to mesenteric lymph nodes partially explains the pathogenesis of spontaneous bacterial peritonitis[J]. J Hepatol, 1994, 21(5): 792-796. DOI: 10.1016/s0168-8278(94)80241-6.
    [7]
    FERNÁNDEZ J, PRADO V, TREBICKA J, et al. Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe[J]. J Hepatol, 2019, 70(3): 398-411. DOI: 10.1016/j.jhep.2018.10.027.
    [8]
    EVANS LT, KIM WR, POTERUCHA JJ, et al. Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites[J]. Hepatology, 2003, 37(4): 897-901. DOI: 10.1053/jhep.2003.50119.
    [9]
    European Association for the Study of the Liver. EASL Clinical Practice Guideline: Occupational liver diseases[J]. J Hepatol, 2019, 71(5): 1022-1037. DOI: 10.1016/j.jhep.2019.08.008.
    [10]
    RUNYON BA, AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012[J]. Hepatology, 2013, 57(4): 1651-1653. DOI: 10.1002/hep.26359.
    [11]
    LI BL, GAO YH, WANG XB, et al. Clinical features and outcomes of bacterascites in cirrhotic patients: A retrospective, multicentre study[J]. Liver Int, 2020, 40(6): 1447-1456. DOI: 10.1111/liv.14418.
    [12]
    BUCSICS T, SCHWABL P, MANDORFER M, et al. Prognosis of cirrhotic patients with fungiascites and spontaneous fungal peritonitis (SFP)[J]. J Hepatol, 2016, 64(6): 1452-1454. DOI: 10.1016/j.jhep.2016.01.039.
    [13]
    AGIASOTELLI D, ALEXOPOULOU A, VASILIEVA L, et al. High serum lipopolysaccharide binding protein is associated with increased mortality in patients with decompensated cirrhosis[J]. Liver Int, 2017, 37(4): 576-582. DOI: 10.1111/liv.13264.
    [14]
    FERNANDES SR, SANTOS P, FATELA N, et al. Ascitic calprotectin is a novel and accurate marker for spontaneous bacterial peritonitis[J]. J Clin Lab Anal, 2016, 30(6): 1139-1145. DOI: 10.1002/jcla.21994.
    [15]
    ICHOU L, CARBONELL N, RAUTOU PE, et al. Ascitic fluid TREM-1 for the diagnosis of spontaneous bacterial peritonitis[J]. Gut, 2016, 65(3): 536-538. DOI: 10.1136/gutjnl-2015-310160.
    [16]
    BRUNS T, SACHSE S, STRAUBE E, et al. Identification of bacterial DNA in neutrocytic and non-neutrocytic cirrhotic ascites by means of a multiplex polymerase chain reaction[J]. Liver Int, 2009, 29(8): 1206-1214. DOI: 10.1111/j.1478-3231.2009.02073.x.
    [17]
    FORBES JD, KNOX NC, RONHOLM J, et al. Metagenomics: The next culture-independent game changer[J]. Front Microbiol, 2017, 8: 1069. DOI: 10.3389/fmicb.2017.01069.
    [18]
    FERNÁNDEZ J, TANDON P, MENSA J, et al. Antibiotic prophylaxis in cirrhosis: Good and bad[J]. Hepatology, 2016, 63(6): 2019-2031. DOI: 10.1002/hep.28330.
    [19]
    MOREAU R, ELKRIEF L, BUREAU C, et al. Effects of long-term norfloxacin therapy in patients with advanced cirrhosis[J]. Gastroenterology, 2018, 155(6): 1816-1827.e9. DOI: 10.1053/j.gastro.2018.08.026.
    [20]
    Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of ascites and complications in cirrhosis[J]. J Clin Hepatol, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.

    中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.
    [21]
    GRANGE JD, AMIOT X. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis[J]. Gastroenterol Clin Biol, 2000, 24(3): 378-379. https://www.researchgate.net/publication/12451361_Effect_of_intravenous_albumin_on_renal_impairment_and_mortality_in_patients_with_cirrhosis_and_spontaneous_bacterial_peritonitis
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