Infections related morbidity and mortality in the cirrhosis of the liver

master's thesis

• Title (croatian): Pobol i ishod akutnih infekcija u cirozi jetre
• Author: Aresa Krasniqi
• Mentor: Vesna Degoricija (mentor)
• Committee member: Vesna Degoricija (predsjednik povjerenstva)
• Committee member: Anna Mrzljak (član povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Bacterial infection is a common complication of liver cirrhosis and accounts for major morbidity and mortality. Cirrhosis associated immune dysfunction and bacterial translocation are the key pathophysiologic mechanisms favoring this increased susceptibility. The most common types of bacterial infections in liver cirrhosis are spontaneous bacterial peritonitis (SBP), urinary tract infection
and pneumonia. Usually these infections are caused by gram negative bacteria. However, in clinical settings, gram positive microbes predominate and more than half of them are multi drug resistant. Due to the altered immune response commonly encountered in liver cirrhosis, presentation of the disease might be atypical. Because of this, diagnosis is often difficult and clinical suspicion should be kept high. The presence of SIRS, increased CRP and procalcitonin are current markers used to facilitate diagnosis and microbiological culture methods are the standard to identify causative agents. Current research is working on newer technologies, that can identify pathogens earlier and hence allow early targeted therapy. Once infection in patients with cirrhosis is suspected, it is crucial to initiate antibiotic treatment immediately, since a delay is associated with increased incidence of complications and death. Antibiotics should be chosen according to type, severity and origin of infection and one should be familiar with the local epidemiological patterns of antibiotic resistance. Prophylactic antibiotic treatment has proven to be efficient, but must be strictly reserved for patients, who are at risk for bacterial infections, in order to prevent emergence of antibiotic resistance. Belonging to this category are patients with upper gastrointestinal bleeding, advanced cirrhosis and previous history of SPB. Despite improvements in prophylaxis and treatment, unfortunately prognosis of infections in liver cirrhosis remains poor. Out of the infected cirrhotic patients approximately 29% die within the first month, 44% within the first three months and 63% within the first year.

Abstract (croatian)

Bakterijske infekcije česta su komplikacija ciroze jetre i odgovorne su za veliki dio mortaliteta i morbiditeta. Disfunkcija imunološkog sustava i translokacija bakterija ključni su patofiziološki mehanizmi koji utječu na veću učestalost bakterijskih infekcija u bolesnika sa cirozom jetre. Najčešći tipovi bakterijskih infekcija u cirozi jetre su: spontani bakterijski peritonitis (SBP), urinarne infekcije i upala pluća. Najčešći uzročnici navedenih infekcija su Gram negativne bakterije, dok u nozokomijalnim infekcijama dominiraju Gram pozitivni (G+) koki. Više od polovice G+ uzročnika je multirezistentno na antibiotike. Radi promijenjenog imunološkog odgovora koji je čest u cirozi jetre, prezentacija bolesti može biti atipična. Posljedično tome, postavljanje točne dijagnoze često je otežano. Prisutnost SIRS-a, povišenog CRP-a i prokalcitonina pokazatelji su prisutnosti infekcije, dok su mikrobiološke kulture standard utvrđivanja uzročnika. Trenutna istraživanja baziraju se na novim tehnologijama koje omogućuju raniju identifikaciju uzročnika i shodno tome raniji početak ciljane antimikrobne terapije. Čim se posumnja na infekciju u bolesnika sa cirozom jetre, od iznimne je važnosti što raniji početak
antibiotske terapije jer odlaganje dovodi do povećane incidencije komplikacija i smrti. Izbor antibiotika mora biti određen na temelju tipa, intenziteta i sijela infekcije uz razmatranje lokalnih epidemioloških podataka o rezistenciji na antibiotike. Profilaktička primjena antibiotika dokazano je učinkovita, mora biti strogo rezervirana za bolesnike koji su u povećanom riziku od bakterijskih infekcija da bi se spriječila pojava rezistencije na antibiotike. Bolesnici koji spadaju u tu kategoriju su oni s krvarenjem iz gornjeg dijela probavnog sustava, uznapredovalom cirozom jetre i sa SBP u anamnezi. Unatoč poboljšanjima u profilaksi i liječenju, prognoza akutne infekcije u bolesnika sa cirozom jetre je loša. Smrtnost bolesnika sa cirozom jetre i infekcijom je 29% u roku od mjesec dana, 44% u roku od tri mjeseca, i 63% u roku od godinu dana.

• Keywords: cirrhosis; bacterial infection; immune dysfunction; antibiotic treatment; mortality
• Keywords (croatian): ciroza; bakterijska infekcija; disfunkcija imunološkog sustava; antibiotsko liječenje; mortalitet
• Language: english
• URN:NBN: urn:nbn:hr:105:566136
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-10-07 11:11:54