Abstract
Infections remain a leading cause of morbidity and mortality among patients with liver
failure. A number of factors, including relative immune dysfunction and systemic inflammation,
bacterial translocation, gut dysbiosis, small intestine bacterial overgrowth, altered
bile acid pools, and changes in pH due to acid suppression, contribute to the high
rates of infection in this population. Though a range of infections can complicate
the course of cirrhotic patients, spontaneous bacterial peritonitis (SBP), cholangitis,
and cholecystitis in addition to other infections (i.e. pneumonia, urinary tract infection,
bacteremia, and Clostridioides difficile colitis) are more common in this population and will be reviewed in this article.
Preventative strategies are directed at minimizing the risk of SBP through the use
of targeted antimicrobial prophylaxis. Lastly, the critically ill cirrhotic patient
may present with an acute need for liver transplantation. Thus, careful assessment
for ongoing infection should be performed and treated to optimize outcomes of transplant,
if needed.
Keywords
cirrhosis - spontaneous bacterial peritonitis - cholangitis - cholecystitis - pneumonia
- UTI - bacteremia and
C. difficile colitis
