Table 2.
Individual pathogens and their clinical manifestations in cirrhotic patients
| Pathogens | Common clinical features | Key points |
| E.coli, Klebsiella spp. Enterobacter spp. and other gram-negative enteric bacteria[6,7,9,12,13] | SBP, bacteremia, UTI, biliary tract infection, meningitis | ↑ Incidence of resistant organisms in hospital-acquired infection and in patients taking prophylactic quinolones |
| Plesiomonas shigelloides [10,81,99] | Septicemia, diarrhea, SBP, meningitis, SSTI | ↑ Incidence in hemochromatosis Risk factors: contaminated food and water |
| Vibrio spp. (V. vulnificus, non-o1 V. cholera, V. parahemolyticus)[10,42,43,57,81] | SSTI, bacteremia, gastroenteritis | ↑ Incidence in cirrhosis, particularly hemochromatosis ↑ Virulence; mortality 50%-60% in bacteremic form and about 24% for SSTI Risk factors: contaminated food and seawater |
| Aeromonas spp. (A. hydrophilla, A. sobria)[44,45,67,70-72] | Bacteremia, biliary tract infection, gastroenteritis, SBP, SSTI | ↑ Incidence ↑ Virulence; mortality 20%-60% Risk factors: contaminated food and water |
| Yersinia spp. (Y. enterocolitica, Y. pseodotuberculosis)[10,81] | Bacteremia, SBP, hepatosplenic abscesses | ↑ Incidence in hemochromatosis ↑ Virulence; mortality about 50% in bacteremic form |
| Campylobacter spp. (C. jejuni, C. fetus)[10,100] | Bacteremia, SBP | ↑ Incidence Mortality about 10% in bacteremic form |
| Pateurella multocida[13,101,102] | SSTI, bacteremia, arthritis, meningitis | ↑ Incidence Mortality about 10% in bacteremic form Risk factors: cat and dog bites or scratches |
| Staphylocccus aureus[7,11,13] | Bacteremia, SSTI, endocarditis | ↑ Incidence, particularly in those who are hospitalized and/or had invasive procedure ↑ Incidence of MRSA carriage and infection |
| Streptococcus pneumonia[94,95] | Bacteremia, pneumonia, SBP, SSTI, meningitis | ↑ Incidence of invasive pneumococcal disease ↑ Virulence Vaccination is recommended |
| Streptococcus group B[103,104] | Bacteremia, SBP, SSTI, pneumonia | ↑ Incidence Mortality 10%-25% |
| Clostridium difficile[80] | Antibiotic-associated diarrhea and colitis | ↑ Incidence ↑ Virulence; mortality 14% Risk factors: hospitalization, antibiotics, proton pump inhibitors |
| Clostridium spp. (C. perfringens, C. bifermentans, C. septicum)[13,105] | Bacteremia, SSTI, peritonitis | ↑ Incidence ↑ Virulence; mortality 54%-65% |
| Enterococcus spp (E. faecium, E. faecalis, E. galinarum)[7,11,59,106-109] | SBP, bacteremia, UTI, endocarditis, biliary tract infection | ↑ Incidence, particularly in hospital-acquired infection and in patients taking prophylactic quinolones ↑ Virulence; mortality rate up to one third in bacteremic form and up to 60% in enterococcal peritonitis Pre-transplant VRE colonization (13%-15% from surveillance) is associated with increased morbidity and mortality following liver transplant |
| Listeria monocytogenes[10,64,81] | Bacteremia, meningitis, SBP | ↑ Incidence in cirrhosis, particularly hemochromatosis |
| Mycobacterium tuberculosis (TB)[73,74,77] | Pulmonary TB, extra-pulmonary TB (e.g. peritonitis, disseminated TB) | ↑ Incidence ↑ Virulence; mortality 22%-48% ↑ Extra-pulmonary forms ↑ Risk for multi-drug resistance TB ↑ Risk for anti-TB hepatotoxicity |
SBP: Spontaneous bacterial peritonitis; UTI: Urinary tract infection; SSTI: Skin and soft tissue infection; TB: Tuberculosis.