Complicanze della cirrosi epatica: le infezioni batteriche.

Bacterial infections represent a severe and frequent clinical problem in patients with liver cirrhosis. The most common sites of infection are the urinary tract followed by the ascitic fluid, blood and lungs. The isolation of pathogen germs occurs only in about 50% of the patients, with a prevalence of Gram-negative in community-acquired infections and Gram-positive in nosocomial infections. However, in the recent years, the long-term norfloxacin prophylaxis and the extensive use of invasive procedures in the management of cirrhotic patients led to a marked increase of Gram-positive infections, particularly if nosocomial, and to the development of quinolone- and trimethoprim/sulfamethoxazoleresistant Gram-negative bacteria. The severity of liver disease and the gastrointestinal bleeding represent the major clinical factors predisposing to infection. Translocation of bacteria and bacterial products from the intestinal lumen to the blood induces the activation of a pro-inflammatory cascade responsible for the worsening of local and systemic hemodynamics, liver function and coagulopathy. Besaides antibiotics, the ise of albumin and, more recently, hydrocortisone has been proposed.