Sylvia Dražilová, Martin Janíčko
Bacterial infections are common complication in patients with cirrhosis, especially in advanced stages; direct pathogenetic
relation of cirrhosis and infections led to their classification among so-called non-specific complications of cirrhosis,
or portal hypertension – together with ascites, hepatic encephalophaty and so on. In their pathogenesis the change
in gut microbiome, bacterial translocation and the change in immunological response play an important role. The most
common infections are spontaneous bacterial peritonitis, urinary tract infections, pneumonia and soft-tissue infections.
Spectrum of the causes has changed at the start of the new millennium. While gram negative bacteria account
for the vast majority of community infections, the representation of gram positive bacteria and multidrug-resistant
bacteria has risen in patients suffering from health care associated and nosocomial infections. Thus, prompt diagnosis
and appropriate antibiotic treatment is crucial. Third-generation cephalosporins are first-line antibiotic treatment only
for patients with community-acquired infections. Prophylaxis is indicated in a strictly chosen group of patients, since
it carries the risk of invoking multidrug resistance. A very important step is the evidence-based indication of the proton
pump inhibitors which predispose to bacterial translocation and significantly increase the risk of spontaneous bacterial
peritonitis.