Bacterial infections in end-stage liver disease: current challenges and future directions.
Bacterial infections in end-stage liver disease: current challenges and future directions.
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DOI：
10.1136/gutjnl-2012-302339
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发表时间：
2012-08
期刊：
影响因子：
24.5
通讯作者：
Kamath PS
中科院分区：
文献类型：
--
作者：
Bajaj JS;O'Leary JG;Wong F;Reddy KR;Kamath PS
问题的范围由于许多原因，肝硬变的感染问题的严重程度是无法量化的。肝硬变患者的感染通常很难识别，因为30e50%的感染，如自发性细菌性腹膜炎(SBP)，可以保持培养阴性。9传统的风险评分方法，如全身炎症反应综合征(SIRS)标准，不能可靠地区分败血症(SIRS合并感染)和非感染性SIRS。10这一点很重要，因为大多数失代偿期终末期肝病患者存在部分SIRS样状态，因此本身不能用来区分感染患者和未感染患者。诊断感染的存在也存在困难，特别是在住院的肝硬变患者中。5检测C反应蛋白和降钙素原等策略可能对选定的患者有帮助，但仍需要一个特定的区分指标。11 12需要采取适时的战略，怀疑感染并及早送出培养物，以便启动适当的抗菌治疗。此外，为了根据需要改变治疗方法，需要加强对潜在耐药生物的怀疑。2此外，目前的大多数研究都是单中心的，关于出现多重耐药菌株和与医疗相关的(在之前90天或180天内接触过医疗服务的患者在入院48小时后发生)和医院感染(在入院后48小时发生)的数据有限。
SCOPE OF THE PROBLEM The magnitude of the problem of infections in cirrhosis is not quantifiable for many reasons.Infections are often difficult to recognise in patients with cirrhosis because 30e50% of infections, such as spontaneous bacterial peritonitis (SBP), can remain culture negative. 9 Conventional risk-scoring strategies, such as the systemic inflammatory response syndrome (SIRS) criteria, cannot reliably differentiate sepsis (SIRS plus infection) from noninfectious SIRS. 10 This is important because a partial SIRS-like state is present in most patients with decompensated end-stage liver disease and therefore in itself cannot be used to differentiate between infected and uninfected patients. There are also difficulties diagnosing the presence of infections, especially in hospitalised cirrhotic patients. 5 Strategies such as measuring C-reactive protein and procalcitonin may be helpful in selected patients, but a specific differentiator is still needed. 11 12 Time-appropriate strategies are needed to suspect infections and send cultures early so as to initiate appropriate antimicrobial therapy. Also a heightened suspicion of potentially resistant organisms is required in order to change therapy as needed. 2 In addition, most current studies are single centre, and there are limited data on the emergence of multiresistant strains and healthcareassociated (which develop< 48 h after admission in patients with previous exposure to healthcare services in the preceding 90 or 180days) and nosocomial (which develop> 48 h after admission) infections.
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影响因子：
13.5
作者：
Belcher, Justin M.;Garcia-Tsao, Guadalupe;Sanyal, Arun J.;Bhogal, Harjit;Lim, Joseph K.;Ansari, Naheed;Coca, Steven G.;Parikh, Chirag R.
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作者：
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通讯作者：
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影响因子：
4.5
作者：
Borzio, M;Salerno, F;Sangiovanni, A
通讯作者：
Sangiovanni, A