Bacterial infection in the pathogenesis of variceal bleeding. Is there any role for antibiotic prophylaxis in the cirrhotic patient?

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Φορέας Ελληνική Γαστροεντερολογική Εταιρία
Συλλογή Annals of Gastroenterology Bacterial infection in the pathogenesis of variceal bleeding. Is there any role for antibiotic prophylaxis in the cirrhotic patient?
Επιμέρους συλλογή Special Topics
ΠεριγραφήSUMMARY Bacterial infections are frequent in cirrhotic patients particularly in those admitted to hospital. Several risk factors have been implicated to explain the propensity of cirrhotic patients to develop bacterial infections, such as iatrogenic factors that may disrupt the natural defense barriers, the occurrence of bacterial translocation from the intestinal lumen to extraintestinal sites, the depression of hepatic reticuloendothelial system function and the decreased opsonic activity of serum and ascitic fluid seen in cirrhosis. Particularly in cirrhotic patients with gastrointestinal hemorrhage, bacterial infections have an incidence of 35% to 66% and are closely related to the recurrence of hemorrhage and survival. Although gastrointestinal hemorrhage can predispose cirrhotic patients to bacteremia there is recent data that support the hypothesis that bacterial infection may initiate gastrointestinal hemorrhage, particularly variceal bleeding in cirrhosis. The strong association between bacterial infections and gastrointestinal hemorrhage in cirrhosis has led to the use of antibiotic prophylaxis in the setting of acute variceal bleeding. A recent meta-analysis demonstrated that antibiotic prophylaxis in cirrhotic patients with gastrointestinal bleeding decreases the rate of bacterial infections and increases short-term survival. Spontaneous bacterial peritonitis (SBP) is the most characteristic infectious complication of cirrhotic patients and it is diagnosed according to certain diagnostic criteria. Third-generation cephalosporins are the first-choice antibiotic treatment in SBP, although selected patients with uncomplicated SBP may be treated with oral quinolones.Selective intestinal decontamination with norfloxacin is safe and effective in the primary and secondary prophylaxis of SBP. Fourth Department of Medicine, Aristotle University
Δημιουργός Goulis J.,
ΕκδότηςAnnals of Gastroenterology
Ημερομηνία2007-03-19
Μορφότυποςapplication/pdf
ΠηγήAnnals of Gastroenterology; Volume 14, No 3 (2001)