1. Novel strategies for the management of bacterial and fungal infections in patients with liver cirrhosis: focus on new antimicrobials
- Author
-
Nicola Schiano Moriello, Antonio Riccardo Buonomo, Salatore Nappa, Biagio Pinchera, Ivan Gentile, Emanuela Zappulo, Riccardo Scotto, Alberto Enrico Maraolo, Maraolo, A. E., Scotto, R., Zappulo, E., Pinchera, B., Schiano Moriello, N., Nappa, S., Buonomo, A. R., and Gentile, I.
- Subjects
0301 basic medicine ,Microbiology (medical) ,Liver Cirrhosis ,medicine.medical_specialty ,Cirrhosis ,Antifungal Agents ,030106 microbiology ,Population ,multidrug-resistant pathogen ,Microbiology ,Liver cirrhosi ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Immune system ,Virology ,Internal medicine ,Drug Resistance, Multiple, Bacterial ,Drug Resistance, Multiple, Fungal ,medicine ,novel beta-lactams ,Humans ,030212 general & internal medicine ,education ,education.field_of_study ,business.industry ,fungal infection ,bacterial infection ,Bacterial Infections ,Antimicrobial ,medicine.disease ,Review article ,Anti-Bacterial Agents ,Infectious Diseases ,Tolerability ,Mycoses ,Etiology ,business - Abstract
Introduction: Liver cirrhosis is a frequent condition caused by different etiologies. Bacterial and fungal infections are common complications, representing an independent prognostic stage in patients with cirrhosis, dramatically worsening their clinical outcomes. Areas covered: The present review article addresses manifold points and to this purpose an inductive literature search of MEDLINE database through PubMed was performed. First, it provides an overview on the mechanisms underlying immune disfunctions in patients with cirrhosis, who are prone to develop infections being at higher risk than the general population. Second, commonest types of bacterial and fungal infections in patients with advanced liver disease are described, focusing on their deleterious impact as decompensating events. Third, the rise of multidrug-resistant (MDR) bacteria and fungi as causative agents of infection in cirrhotic subjects is illustrated. Eventually, the most promising novel therapeutic options against MDR pathogens and fungi are reviewed. Expert opinion: The management of bacterial and fungal infections in patients with cirrhosis is difficult, due to the frequent co-existence of renal impairment, low platelet count and other conditions that limit the antimicrobial choice. New antibacterial and antifungal compounds may overcome this issue by providing a better tolerability profile, along with equal or superior efficacy compared with older drugs.
- Published
- 2020