Novel strategies for the management of bacterial and fungal infections in patients with liver cirrhosis: focus on new antimicrobials

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.

KEYWORDS:

• Liver cirrhosis
• bacterial infections
• fungal infections
• multidrug-resistant pathogens
• novel beta-lactams

Article highlights

• Liver cirrhosis is a relevant comorbidity worldwide. Bacterial and fungal infection are among the most important decompensating events.

• Patients with cirrhosis suffer from immune dysfunction linked to the systemic effects of liver disease. The most frequent infectious complications are spontaneous bacterial (or fungal) peritonitis, urinary tract infections, pneumonia, bloodstream infections.

• The spread of multidrug-resistant bacteria and the increasing role of fungi as causative agents of infections in patients with cirrhosis are an important challenge, making difficult the choice of appropriate empirical antimicrobial therapy.

• The advent of new antibacterial and antifungal molecules enlarges the antimicrobial armamentarium for all types of patients, but it is critical in cirrhotic subjects by providing potentially safer and more tolerated compounds.

Declaration of interest

I Gentile has acted as consultant for MSD, AbbVie, Correvio, Pfizer, Nordic. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.