cefotaxime and Liver-Failure

Bacterial infections are common complications in patients with cirrhosis or liver failure and are correlated with high mortality. Clinical practice guideline (CPG) is a reference used to help clinicians make decisions. This systematic appraisal aimed to evaluate the methodological quality and summarize the recommendations of reported CPGs in these patients.. We systematically searched CPGs published from 2008 to 2019. The methodological quality of the included CPGs was assessed using the AGREE II instrument. We extracted and compared recommendations for prophylactic and empirical treatment strategies.. Fourteen CPGs with a median overall score of 56.3% were included. The highest domain score was Clarity of Presentation (domain 4, 85.4%), and the lowest was for Stakeholder Involvement (domain 2, 31.3%). Three CPGs had an overall score above 80%, and 6 CPGs had a score above 90% in domain 4. Prophylaxis should be strictly limited to patients with varicose bleeding, low ascites protein levels and a history of spontaneous bacterial peritonitis. Fluoroquinolones (norfloxacin and ciprofloxacin), third-generation cephalosporins (G3) (ceftriaxone and cefotaxime) and trimethoprim-sulfamethoxazole (SXT) are recommended for preventing infections in patients with cirrhosis or liver failure. G3, β-lactam/β-lactamase inhibitor combinations (BLBLIs) and carbapenems are recommended as the first choice in empirical treatment according to local epidemiology of bacterial resistance.. The methodological quality of CPGs focused on patients with cirrhosis or liver failure evaluated by the AGREE II instrument is generally poor. Three CPGs that were considered applicable without modification and 6 CPGs that scored above 90% in domain 4 should also be paid more attention to by healthcare practitioners. Regarding recommendations, norfloxacin, ciprofloxacin, ceftriaxone, cefotaxime, and SXT are recommended for prophylactic treatment appropriately. G3, BLBLIs, and carbapenems are recommended for use in empirical treatment strategies.

Topics: Anti-Bacterial Agents; Cefotaxime; Ciprofloxacin; Humans; Liver Cirrhosis; Liver Failure

Although numerous studies on abnormality of neutrophil function in patients with viral hepatitis have previously been reported, little is known about mechanisms of neutrophil dysfunction. To investigate mechanisms of neutrophil dysfunction in these patients, neutrophil membrane fluidity was measured by fluorescence polarization technique in 76 hepatitis patients. The results showed that membrane fluidity of neutrophils from patients with chronic active hepatitis (CAH) or subfulminant hepatic failure (SFHF) was much lower than that in normal controls (p < 0.01), but such a difference could not be found in patients with acute hepatitis (p > 0.05). Furthermore, recombinant interleukin-2 could significantly increase membrane fluidity, while lipopolysaccharide decreased membrane fluidity of neutrophils (p < 0.01, p < 0.001). The present study indicates that there is abnormal membrane fluidity of neutrophils in patients with CAH and SFHF. Neutrophil dysfunction in hepatitis patients may be partly due to altered membrane fluidity.

Topics: Adolescent; Adult; Cefotaxime; Cell Membrane; Female; Fluorescence Polarization; Hepatitis B; Humans; In Vitro Techniques; Interleukin-2; Lipopolysaccharides; Liver Failure; Male; Membrane Fluidity; Middle Aged; Neutrophils; Recombinant Proteins

Cefotaxime is the most commonly used antibiotic for initial therapy of spontaneous bacterial peritonitis in cirrhosis. However, since the introduction of cefotaxime no study has been performed to investigate factors influencing prognosis in cirrhotic patients with this type of infection. In this study, predictive factors for infection resolution and patient survival were investigated in 213 consecutive episodes of spontaneous bacterial peritonitis in 185 cirrhotic patients. All patients were initially treated with cefotaxime. One hundred sixty-five episodes (77%) resolved with cefotaxime alone, and two more episodes (1%), initially unresponsive to cefotaxime, were cured after modification of antibiotic therapy. In a multivariate analysis (stepwise logistic regression), only 4 of 51 clinical and laboratory variables obtained at the time of diagnosis of infection were identified as independent predictors of infection resolution: band neutrophils in white blood cell count, community-acquired vs. hospital-acquired peritonitis, blood urea nitrogen level and serum aspartate aminotransferase level. No patient experienced serious adverse effects related to cefotaxime. Eighty-two patients died during hospitalization (38% mortality rate in relation to the 213 episodes of peritonitis). In the multivariate analysis, six variables were independently correlated with survival: blood urea nitrogen level, serum aspartate aminotransferase level, community-acquired vs. hospital-acquired peritonitis, age, Child-Pugh score and ileus. No microbiological data had predictive value for infection resolution or survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Female; Humans; Liver Cirrhosis; Liver Failure; Male; Middle Aged; Peritonitis; Prognosis; Retrospective Studies; Survival Analysis; Treatment Outcome