Acute hemorrhage from esophageal varices due to portal hypertension is a frequent and serious complication of liver cirrhosis. Bacterial infection may be one of the factors influencing such hemorrhage. Endotoxins may increase portal tension and at the same time result in primary hemostasis disorder, thus becoming one of the causes of hemorrhage. The authors of the paper compared the incidence of bacterial infection in 53 patients with varicose hemorrhage due to portal hypertension with 62 patients with liver cirrhosis and portal hypertension without varicose hemorrhage. At least one pathogen was found in considerable 61.1% of the total of patients in the liver cirrhosis group, while the difference between the two groups was but insignificant. No statistically significant difference was found between the group of patients with hemorrhage and those without hemorrhage in terms of presence of bacterial infection in hemoculture, urine, throat, faeces and ascites, nor was there a difference in the etiology of the G+ bacteria, G- bacteria or fungi and yeast infectious agents in the hemoculture, urine, throat, faeces and ascites in either of the groups. No statistically significant difference was found in comparing the patients with a recurrence of hemorrhage (or with mortality) and with infection with those without recurrence of hemorrhage. Bacterial infection was more often found in patients with a recurrence of hemorrhage (75%) as compared with those without any recurrence (52%), and also in patients who died bacterial infection was proven more often than in those who survived (61.9% vs. 58.1%, respectively). There was no difference in morbidity or recurrence of hemorrhage between the patients treated with norfloxacin and ampicilin/sulbactam. No statistically significant difference was recorded between the 1st and 5th day in terms of decrease in bacterial infection. A significant difference was found in the urine etiological agent, where a significant increase in the share of fungal and yeast urine infection (p = 0.011) was recorded after the application of the therapy, as well as a drop in urine infection caused by the G- bacterial agent (p = 0.057).
- MeSH
- bakteriální infekce komplikace MeSH
- ezofageální a žaludeční varixy mikrobiologie MeSH
- gastrointestinální krvácení mikrobiologie MeSH
- jaterní cirhóza mikrobiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- portální hypertenze mikrobiologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
OBJECTIVE: To determine the effect of Escherichia coli Nissle (Mutaflor, Ardeypharm GmbH, Herdecke, Germany) on the intestinal colonization, level of endotoxin and liver functions in patients with liver cirrhosis. METHODS: Thirty-nine patients with liver cirrhosis diagnosed by means of biopsy and clinical examinations were randomly allocated to treatment with E. coli Nissle or placebo for 42 days. Standard clinical examination, biochemical and hematological examinations, level of endotoxin and microbiological examination of the stool were performed before and after the treatment. RESULTS: In comparing the treatment of E. coli Nissle and placebo, significant improvement of the intestinal colonization (P<0.001) in the E. coli Nissle group was described. We found a trend of significant lowering of the endotoxemia (P=0.07) and improvement of liver functions evaluated by Child-Pugh score (P=0.06). CONCLUSION: E. coli Nissle seems to be effective in the restoration of normal colonic colonization and can probably lower endotoxemia in cirrhotic patients.
- MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- endotoxemie komplikace terapie MeSH
- endotoxiny krev MeSH
- Escherichia coli * MeSH
- feces mikrobiologie MeSH
- jaterní cirhóza komplikace mikrobiologie patofyziologie terapie MeSH
- játra patofyziologie MeSH
- kolon mikrobiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- probiotika terapeutické užití MeSH
- senioři MeSH
- stupeň závažnosti nemoci MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- Názvy látek
- endotoxiny MeSH
The purpose of the study was to verify effects of Escherichia coli Nissle (Mutaflor) on intestinal colonisation, endotoxin levels, hepatic encephalopathy and liver function in patients with liver cirrhosis. The study involved 39 patients (22 taking Mutaflor and 17 taking placebo). Even though the number combination test showed extended reaction time in patients with described minimal hepatic encephalopathy the drop was not significant in the trend evaluation. However, the treated group displayed significant improvement of intestinal colonisation (p < 0.001) and a trend towards significant reduction of endotoxin levels on day 42 (p = 0.07) and improvement of liver function assessed with the Child-Pugh classification on days 42 and 84 (p = 0.06). Probiotic preparations can therefore represent a significant contribution to this group therapy.
- MeSH
- dospělí MeSH
- endotoxiny krev MeSH
- Escherichia coli * MeSH
- jaterní cirhóza komplikace mikrobiologie patofyziologie terapie MeSH
- jaterní encefalopatie etiologie psychologie MeSH
- játra patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- probiotika terapeutické užití MeSH
- senioři MeSH
- střeva mikrobiologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- Názvy látek
- endotoxiny MeSH
BACKGROUND/AIMS: Acute bleeding from the upper gastrointestinal tract is a common and serious complication of liver cirrhosis. It is believed that bacterial infection may be the immediate cause of the bleeding and the latest meta-analyses show that bacterial infection is an independent predictive factor of the failure to stop bleeding. METHODOLOGY: The authors evaluated the presence of bacterial infection (blood, urine, throat and ascitic fluid) in 35 consecutive patients with liver cirrhosis and acute bleeding with portal hypertension and compared these results with a group of 35 patients with liver cirrhosis with portal hypertension without acute bleeding. RESULTS: According to the results obtained, there is a statistically higher incidence of bacterial infection among patients with acute bleeding with portal hypertension (25 of 35 patients, 71%) than among patients with liver cirrhosis and portal hypertension without acute bleeding (14 of 35 patients, 40%, p < 0.01). The incidence of bacteriological findings in blood and throat samples is statistically higher in patients with acute bleeding as opposed to the control group (p < 0.05). CONCLUSIONS: These results confirm the necessity of administering antibiotic prophylaxis to all cirrhotic patients with variceal bleeding, not just to those with confirmed infection or symptoms thereof.
- MeSH
- antibiotická profylaxe MeSH
- bakteriální infekce komplikace MeSH
- dospělí MeSH
- gastrointestinální krvácení etiologie mikrobiologie MeSH
- jaterní cirhóza komplikace mikrobiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- portální hypertenze komplikace mikrobiologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
An acute bleeding from oesophageal varices as a result of portal hypertension is a frequent and at the same time serious complication of cirrhosis of the liver. One of factors influencing this bleeding can be a bacterial infection. Endotoxines can increase portal pressure and so participate in development of bleeding and simultaneously deteriorate a patient's prognosis. An antibiotic treatment is a part of a treatment algorithm, however what antibiotics to administer and in what manner is unclear. A group of 46 patients who were admitted to a hospital for an acute bleeding from varices has been compared in the study to 48 cirrhosis patients hospitalised for other reasons. An infection incidence was high in both groups (63.0 % vs. 54.2 %), bleeding patients had more often positive hemoculture (17.3 % vs. 8.6 %), and statistically significantly more often positive findings in throat swab culture (36.9 % vs. 17.3 %, p = 0.04) which is an evidence of an increased pathology colonisation of these patients. Bleeding patients were randomised for peroral norfloxacin administration (n = 25) or an intravenous administration of a combination of ampicilin and sulbactam (n = 21). There was no difference in survival of both groups. Due to a high number of bacterial infections antibiotics administration has been indicated in these patients. Intravenous administration is probably of the same effect as peroral administration.
- MeSH
- ampicilin aplikace a dávkování MeSH
- antibakteriální látky aplikace a dávkování MeSH
- aplikace orální MeSH
- bakteriální infekce komplikace diagnóza farmakoterapie MeSH
- dospělí MeSH
- ezofageální a žaludeční varixy komplikace mikrobiologie MeSH
- gastrointestinální krvácení etiologie mikrobiologie MeSH
- intravenózní infuze MeSH
- jaterní cirhóza komplikace mikrobiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- norfloxacin aplikace a dávkování MeSH
- portální hypertenze komplikace mikrobiologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- sulbaktam aplikace a dávkování MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- Názvy látek
- ampicilin MeSH
- antibakteriální látky MeSH
- norfloxacin MeSH
- sulbaktam MeSH
- sultamicillin MeSH Prohlížeč
AIM OF THE STUDY: To assess the objective incidence of infectious complications in liver cirrhosis, to find out correlation among stage of liver cirrhosis, number of infectious complications and mortality in cirrhotic patients. PATIENTS AND METHODS: 93 patients with liver cirrhosis were hospitalized from June 1996 to November 1998 (age: 53,44 I 8,03 years, Child-Pugh score: 11,58 I 2,12). 6 patients were in class B, 87 in class C of Child-Pugh classification. Ascites was found in 81 patients, pleural effusion was found in 14 patients. Chest X-ray, examination of ascites and pleural efussion an urine culture were performed by admission, the other infections were actively screened after clinical signs. RESULTS: Spontaneous bacterial peritonitis was found in 17 patients (18,28 %), secondary bacterial peritonitis in 5 patients (5,38 %), spontaneous bacteremia in 3 patients (3,23 %), spontaneous bacterial pleuritis in 3 patients (3,23 %), bronchopneumonia and infections of respiratory tract in 22 patients (23,66 %), uro-infection in 69 patients (74,19 %) and the other kinds of infection in 14 patients (15,05 %). Mortality of patients correlates with stage of liver cirrhosis and number of infectious complications. CONCLUSION: Infections are common complications in hospitalized cirrhotics. Infectious complications are the most common cause of mortality of cirrhosis, patients with bronchopneumonia, secondary bacterial peritonitis or spontaneous bacterial pleuritis had bad prognosis. Early antibiotic treatment at the base of culture and sensitivity is an optimal therapeutic approach in cirrhotics with infections.
Incidence of bacterial infections in hospitalised patients with liver disease is high. Due to a liver dysfunction immune reactivity is significantly impaired and bacterial infections are more frequent. Also incidence of nosocomial infections is higher in patients with liver disease compared to patients hospitalised for other conditions. To make a differential diagnosis of infectious and non-infectious aetiology of an inflammation is very difficult. Characteristic laboratory tests for bacterial infection include test of a number of leucocytes in peripheral blood, differential count of leucocytes, erythrocyte sedimentation, procalcitonin, C-reactive protein, tumor necrosis factor alpha, interleukin-1, interleukin-6, interleukin-8, and complement fragment C3a. Clinically the most significant are C-reactive protein test and procalcitonin test. Procalcitonin is a protein, a calcitonin precursor, which is in healthy individuals produced by cells of thyroid gland. A half-life of procalcitonin in serum is 20-24 hours which makes it suitable for daily monitoring and enables to control a course of treatment and to distinguish bacterial infection from other types of inflammations. Procalcitonin levels rise in bacterial, parasite, and yeast infections. Elevated procalcitonin levels appear only in inflammations of an infectious etiology with systemic signs. In patients with liver cirrhosis bacterial infections are more frequent. They usually include spontaneous bacterial peritonitis, infection of the respiratory system, urinary infections, and bacteremia. A timely proof of a bacterial infection and an appropriate and effective antibiotic therapy lead to an improvement of the general state of a patient and to his/her better prognosis. Procalcitonin determination is appropriate for diagnosing infections and control of treatment.
- MeSH
- bakteriální infekce komplikace diagnóza MeSH
- biologické markery krev MeSH
- diferenciální diagnóza MeSH
- jaterní cirhóza mikrobiologie MeSH
- kalcitonin krev MeSH
- lidé MeSH
- peptid spojený s genem pro kalcitonin MeSH
- proteinové prekurzory krev MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- Názvy látek
- biologické markery MeSH
- CALCA protein, human MeSH Prohlížeč
- kalcitonin MeSH
- peptid spojený s genem pro kalcitonin MeSH
- proteinové prekurzory MeSH
Acute haemorrhage from the upper gastrointestinal tract is a frequent and serious complication which affects 20-60% patients with cirrhosis of the liver and portal hypertension. It is assumed that bacterial infections can be the direct cause of haemorrhage but accurate data on the influence of infection on the development and course of haemorrhage are lacking. Acute haemorrhage as a result of portal hypertension has a very high mortality, 30-50%, and an early relapse of haemorrhage occurs in as many as 40% of these patients. Most recent meta-analyses indicate that bacterial infection is an independent prognostic factor in failure of haemostasis and has a significant impact on the mortality of these patients. The authors examined for the presence of bacterial infection (blood, urine, throat, ascites) 25 patients with cirrhosis of the liver and acute haemorrhage as a result of portal hypertension and compared the results with a group of 25 patients with cirrhosis of the liver and portal hypertension without acute haemorrhage. According to the results in patients with acute haemorrhage due to portal hypertension there is a significantly higher incidence of bacterial infections than in patients with cirrhosis of the liver and portal hypertension without acute haemorrhage. The results confirm the necessity to administer antibiotic prophylaxis to cirrhotic patients with varicose bleeding, not only to patients with symptoms and evidence of infection but also in their absence. Antibiotic prophylaxis extends the survival period of these patients.
- MeSH
- akutní nemoc MeSH
- bakteriální infekce komplikace MeSH
- dospělí MeSH
- gastrointestinální krvácení etiologie mikrobiologie MeSH
- jaterní cirhóza mikrobiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- portální hypertenze komplikace MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- práce podpořená grantem MeSH
