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The chronic use of beta‐blockers and proton pump inhibitors may affect the rate of bacterial infections in cirrhosis
Author(s) -
Merli Manuela,
Lucidi Cristina,
Di Gregorio Vincenza,
Giannelli Valerio,
Giusto Michela,
Ceccarelli Giancarlo,
Riggio Oliviero,
Venditti Mario
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12593
Subject(s) - cirrhosis , medicine , gastroenterology , antibiotics , proton pump inhibitor , risk factor , spontaneous bacterial peritonitis , microbiology and biotechnology , biology
Background & Aims Bacterial infections are among the most common and life‐threatening complications in cirrhosis. Qualitative and quantitative modifications of the gut microbiota, dysfunction of the intestinal barrier and multiple immune defects are factors that contribute to a pathological ‘bacterial translocation’ ( BT ), leading to a higher susceptibility to infections in cirrhotic patients. Long‐term therapies, commonly adopted in cirrhotic patients, may influence BT and modify the risk of infection in these patients. To investigate the influence of chronic therapies on the prevalence and microbiological characteristics of infections in cirrhosis. Methods Consecutive cirrhotic patients hospitalised from 2008 to 2013 were enrolled. All previous treatments were carefully recorded. Infections were actively sought out, patients were actively monitored for infection, and possible risk factors were evaluated. Results Four hundred cirrhotic patients were included. The most frequent therapies were proton pump inhibitors ( PPI s) (67%), non‐absorbable‐disaccharides (44%), beta‐blockers ( BB s) (39%) and non‐absorbable‐antibiotics (10%). Child‐Pugh C ( P < 0.001; OR 5; 95% CI : 2.6–9.9) and PPI therapy ( P = 0.008; OR 2; 95% CI : 1.2–3.2) were found to be independent predictors of infection, and the use of BB s was a protective factor ( P = 0.001; OR 0.46; 95% CI : 0.3–0.7). Cirrhotic patients with bacterial infection showed lower morbidity and mortality when taking BB s. Conclusions Proton pump inhibitors increase the risk of infection in cirrhosis and should not be prescribed in these patients without specific indications. In contrast, the use of BB s is associated with a lower rate of infection and attenuates the consequences of infections in cirrhotic patients.